Provider Demographics
NPI:1184209900
Name:OCHSNER KIDNEY CARE LLC
Entity Type:Organization
Organization Name:OCHSNER KIDNEY CARE LLC
Other - Org Name:OCHSNER KIDNEY CARE - JEFFERSON HIGHWAY
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-421-2690
Mailing Address - Street 1:4000 COVER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1790
Mailing Address - Country:US
Mailing Address - Phone:562-421-2690
Mailing Address - Fax:562-453-0677
Practice Address - Street 1:320 MAINE STREET
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121
Practice Address - Country:US
Practice Address - Phone:504-273-0810
Practice Address - Fax:504-273-0811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment