Healthcare Provider Details

I. General information

NPI: 1144427741
Provider Name (Legal Business Name): NAMG HOME DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 12/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 PARK SIERRA DR STE 103
RIVERSIDE CA
92505-3081
US

IV. Provider business mailing address

5200 VIRGINIA WAY L&C DEPT
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 951-373-4004
  • Fax: 951-373-4005
Mailing address:
  • Phone: 615-341-5895
  • Fax: 866-890-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES K HILGER
Title or Position: SENIOR L&C ADMINISTRATOR
Credential:
Phone: 615-341-6789