Provider Demographics
NPI:1740233154
Name:QUALITY RENAL CARE LLC
Entity Type:Organization
Organization Name:QUALITY RENAL CARE LLC
Other - Org Name:QRC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RENAL ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GIRARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-426-6456
Mailing Address - Street 1:2203 RANDALL ROAD
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110
Mailing Address - Country:US
Mailing Address - Phone:847-426-6456
Mailing Address - Fax:847-426-4795
Practice Address - Street 1:2203 RANDALL ROAD
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110
Practice Address - Country:US
Practice Address - Phone:847-426-6456
Practice Address - Fax:847-426-4795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-12-19
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
IL=========001Medicaid
IL=========001Medicaid