Provider Demographics
NPI:1598197055
Name:TOTAL RENAL CARE
Entity Type:Organization
Organization Name:TOTAL RENAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHREN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:323-268-2729
Mailing Address - Street 1:1936 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-3413
Mailing Address - Country:US
Mailing Address - Phone:323-268-2729
Mailing Address - Fax:
Practice Address - Street 1:1936 E 1ST ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-3413
Practice Address - Country:US
Practice Address - Phone:323-268-2729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment