MEDICARE: KIDNEY DIALYSIS CENTER OF VERDUGO HILLS,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	:	1457396889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDNEY DIALYSIS CENTER OF VERDUGO HILLS,LLC

Provider Business Mailing Address
First Line	:	2400 DALLAS PKWY
Second Line	:	SUITE 350
City	:	PLANO
State	:	TX
Zip	:	75093-4370
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 VERDUGO BLVD
Second Line	:	SUITE # 200
City	:	GLENDALE
State	:	CA
Zip	:	91208-1477
Country	:	US
Telephone Number	:	805-433-7777
Fax Number	:	805-433-7655

Authorized Official
Title or Position	:	SENIOR VP/GENERAL COUNSEL
Name	:	THOMAS L. WEINBERG
Credential	:
Telephone Number	:	214-736-2730

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	11/22/2013

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