Provider Demographics
NPI:1730479072
Name:RAI CARE CENTERS OF SOUTHERN CALIFORNIA I, LLC
Entity Type:Organization
Organization Name:RAI CARE CENTERS OF SOUTHERN CALIFORNIA I, LLC
Other - Org Name:RAI - SOUTH BRAND - SAN FERNANDO
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 1:501 S BRAND BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-4929
Mailing Address - Country:US
Mailing Address - Phone:818-365-5270
Mailing Address - Fax:818-837-2634
Practice Address - Street 1:501 S BRAND BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4929
Practice Address - Country:US
Practice Address - Phone:818-365-5270
Practice Address - Fax:818-837-2634
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-07
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
CA1730479072Medicaid
CA552687Medicare Oscar/Certification