Provider Demographics
NPI:1144427741
Name:NAMG HOME DIALYSIS LLC
Entity Type:Organization
Organization Name:NAMG HOME DIALYSIS LLC
Other - Org Name:MAGNOLIA WEST AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR L&C ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:HILGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-341-6789
Mailing Address - Street 1:5200 VIRGINIA WAY
Mailing Address - Street 2:L&C DEPT
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7569
Mailing Address - Country:US
Mailing Address - Phone:615-341-5895
Mailing Address - Fax:866-890-5560
Practice Address - Street 1:3660 PARK SIERRA DR
Practice Address - Street 2:STE 103
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3081
Practice Address - Country:US
Practice Address - Phone:951-373-4004
Practice Address - Fax:951-373-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1144427741Medicaid
CA552617Medicare Oscar/Certification