Healthcare Provider Details

I. General information

NPI: 1154374650
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: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 B GREENLEE STREET
MARENGO IL
60152
US

IV. Provider business mailing address

910 B GREENLEE STREET
MARENGO IL
60152
US

V. Phone/Fax

Practice location:
  • Phone: 815-568-5800
  • Fax: 815-568-5900
Mailing address:
  • Phone: 815-568-5800
  • Fax: 815-568-5900

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