Provider Demographics
NPI:1457451403
Name:QUALITY CARE DIALYSIS CENTER OF VEGA BAJA, INC.
Entity Type:Organization
Organization Name:QUALITY CARE DIALYSIS CENTER OF VEGA BAJA, INC.
Other - Org Name:VEGA BAJA RENAL DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:RD PR 2 KM 39.5
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-0000
Mailing Address - Country:US
Mailing Address - Phone:787-858-3355
Mailing Address - Fax:787-855-2762
Practice Address - Street 1:RD PR 2 KM 39.5
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-0000
Practice Address - Country:US
Practice Address - Phone:787-858-3355
Practice Address - Fax:787-855-2762
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2023-10-13
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
PR037979300Medicaid