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NPI Code Detail

MEDICARE: GAREY DIALYSIS CENTER PARTNERSHIP

MEDICARE: GAREY DIALYSIS CENTER PARTNERSHIP
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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1052820OTHERCABLUE CROSS OF CALIFORNIA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3052820OTHERCAPTAN
4ZZZR0223ZOTHERCABLUE SHIELD OF CALIFORNIA

General Provider Information

NPI Number : 1861567620
Entity Type Code : Organization
Provider Name (Legal Business Name) : GAREY DIALYSIS CENTER PARTNERSHIP
Provider Business Mailing Address
First Line : 120 W FOOTHILL BLVD
Second Line :
City : GLENDORA
State : CA
Zip : 91741-3364
Country : US
Telephone Number : 626-335-7551
Fax Number : 626-335-0962
Provider Business Practice Location Address
First Line : 120 W FOOTHILL BLVD
Second Line :
City : GLENDORA
State : CA
Zip : 91741-3364
Country : US
Telephone Number : 626-335-7551
Fax Number : 626-335-0962
Authorized Official
Title or Position : VICE PRESIDENT
Name : BARRY L. BLANTON
Credential :
Telephone Number : 781-699-9000
Provider Enumeration Date : 11/21/2006
Last Update Date : 10/17/2023

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Directions to “GAREY DIALYSIS CENTER PARTNERSHIP ” Practice Location

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