MEDICARE: QUALITY RENAL CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1154374650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY RENAL CARE LLC

Provider Business Mailing Address
First Line	:	910 B GREENLEE STREET
Second Line	:
City	:	MARENGO
State	:	IL
Zip	:	60152
Country	:	US
Telephone Number	:	815-568-5800
Fax Number	:	815-568-5900

Provider Business Practice Location Address
First Line	:	910 B GREENLEE STREET
Second Line	:
City	:	MARENGO
State	:	IL
Zip	:	60152
Country	:	US
Telephone Number	:	815-568-5800
Fax Number	:	815-568-5900

Authorized Official
Title or Position	:	RENAL ADMINISTRATOR
Name	:	MRS. BETH ANN GIRARD
Credential	:	RN
Telephone Number	:	847-426-6456

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	11/22/2011

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