Healthcare Provider Details

I. General information

NPI: 1740233154
Provider Name (Legal Business Name): QUALITY RENAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 RANDALL ROAD
CARPENTERSVILLE IL
60110
US

IV. Provider business mailing address

2203 RANDALL ROAD
CARPENTERSVILLE IL
60110
US

V. Phone/Fax

Practice location:
  • Phone: 847-426-6456
  • Fax: 847-426-4795
Mailing address:
  • Phone: 847-426-6456
  • Fax: 847-426-4795

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: MRS. BETH ANN GIRARD
Title or Position: RENAL ADMINISTRATOR
Credential: RN
Phone: 847-426-6456