Provider Demographics
NPI:1588849541
Name:RSA - GUAM, LLC
Entity Type:Organization
Organization Name:RSA - GUAM, LLC
Other - Org Name:U.S. RENAL CARE SINAJANA DIALYSIS
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 1:736 ROUTE 4 STE 101
Mailing Address - Street 2:
Mailing Address - City:SINAJANA
Mailing Address - State:GU
Mailing Address - Zip Code:96910-3368
Mailing Address - Country:US
Mailing Address - Phone:671-475-3600
Mailing Address - Fax:671-477-2759
Practice Address - Street 1:736 ROUTE 4 STE 101
Practice Address - Street 2:
Practice Address - City:SINAJANA
Practice Address - State:GU
Practice Address - Zip Code:96910-3368
Practice Address - Country:US
Practice Address - Phone:671-475-3600
Practice Address - Fax:671-477-2759
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-08
Last Update Date:2023-10-23
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
GU191Medicaid
GU652501Medicare Oscar/Certification