Provider Demographics
NPI:1497829790
Name:RAI CARE CENTERS OF NORTHERN CALIFORNIA I, LLC
Entity Type:Organization
Organization Name:RAI CARE CENTERS OF NORTHERN CALIFORNIA I, LLC
Other - Org Name:RAI-CHADBOURNE-FAIRFIELD
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 1:490 CHADBOURNE RD STE D
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-9613
Mailing Address - Country:US
Mailing Address - Phone:707-434-9088
Mailing Address - Fax:707-434-9101
Practice Address - Street 1:490 CHADBOURNE RD STE D
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9613
Practice Address - Country:US
Practice Address - Phone:707-434-9088
Practice Address - Fax:707-434-9101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2023-10-17
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
CACDC52522GMedicaid
CA552522OtherBLUE CROSS OF CALIFORNIA
CAZZZR0193ZOtherBLUE SHIELD OF CALIFORNIA
CA06OtherKAISER
CAZZZR0193ZOtherBLUE SHIELD OF CALIFORNIA