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General NPI Number Information
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NPI Number | 1376502831
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Entity Type | Organization
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Legal Business Name | TOTAL RENAL CARE INC
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 3600 E MARTIN LUTHER KING JR BLVD
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City | LYNWOOD
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State | CA
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Zip | 90262-2607
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Country | US
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Telephone | 310-886-5156
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Fax | 310-608-6947
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Provider Business Mailing Address
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Address Line | 5200 VIRGINIA WAY ATT: L&C DEPT
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City | BRENTWOOD
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State | TN
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Zip | 37027-7569
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP, LICENSURE & CERTIFICATION
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Name | SAMUEL T. WEY
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Credential |
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Telephone | 615-341-6641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 930000083
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License Number State | CA
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