Provider Demographics
NPI:1669546990
Name:RAI CARE CENTERS OF NORTHERN CALIFORNIA I, LLC
Entity type:Organization
Organization Name:RAI CARE CENTERS OF NORTHERN CALIFORNIA I, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:545 E CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5531
Mailing Address - Country:US
Mailing Address - Phone:209-943-0854
Mailing Address - Fax:209-943-0536
Practice Address - Street 1:545 E CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5531
Practice Address - Country:US
Practice Address - Phone:209-943-0854
Practice Address - Fax:209-943-0536
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2023-11-02
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
CAZZZR0196ZOtherBLUE SHIELD OF CALIFORNIA
CA04OtherKAISER
CA052705OtherBLUE CROSS OF CALIFORNIA
CA1669546990Medicaid
CACDC02705JMedicaid