Provider Demographics
NPI:1629275383
Name:RAI CARE CENTERS OF GOLDENWEST, LLC
Entity Type:Organization
Organization Name:RAI CARE CENTERS OF GOLDENWEST, LLC
Other - Org Name:RAI - GOLDENWEST - WESTMINSTER
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 1:15330 GOLDENWEST ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6150
Mailing Address - Country:US
Mailing Address - Phone:714-373-1543
Mailing Address - Fax:714-892-9619
Practice Address - Street 1:15330 GOLDENWEST ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6150
Practice Address - Country:US
Practice Address - Phone:714-373-1543
Practice Address - Fax:714-892-9619
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-27
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
CA552598Medicare Oscar/Certification