Provider Demographics
NPI:1619432598
Name:KAISER FOUNDATION HOSPITALS
Entity Type:Organization
Organization Name:KAISER FOUNDATION HOSPITALS
Other - Org Name:OUTPATIENT SERVICES - PERITONEAL DIALYSIS AT KAISER MORENO VALLEY CAPD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP AND AREA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-353-4601
Mailing Address - Street 1:27200 IRIS AVENUE MOB 2
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4803
Mailing Address - Country:US
Mailing Address - Phone:951-251-6205
Mailing Address - Fax:
Practice Address - Street 1:27200 IRIS AVENUE MOB 2
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4803
Practice Address - Country:US
Practice Address - Phone:951-251-6205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAISER FOUNDATION HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-05
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment