Provider Demographics
NPI:1245344654
Name:BALDWIN HILLS DIALYSIS CENTER
Entity type:Organization
Organization Name:BALDWIN HILLS DIALYSIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-293-4488
Mailing Address - Street 1:3705 S LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-5309
Mailing Address - Country:US
Mailing Address - Phone:323-293-4488
Mailing Address - Fax:323-293-4499
Practice Address - Street 1:3705 S. LABREA AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016
Practice Address - Country:US
Practice Address - Phone:323-293-4488
Practice Address - Fax:323-293-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000904261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC02806FMedicaid
CAZZZ57405ZOtherBLUE SHIELD OF CALIFORNIA
CACDC02806FMedicaid