Provider Demographics
NPI:1720152994
Name:RAI CARE CENTERS OF NORTHERN CALIFORNIA II, LLC
Entity Type:Organization
Organization Name:RAI CARE CENTERS OF NORTHERN CALIFORNIA II, LLC
Other - Org Name:RAI-CESAR CHAVEZ-SAN FRANCISCO
Other - Org Type:Other Name
Authorized Official - Title/Position:REGULATORY AFFAIRS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:1750 CESAR CHAVEZ
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-1138
Mailing Address - Country:US
Mailing Address - Phone:415-206-9775
Mailing Address - Fax:415-206-9640
Practice Address - Street 1:1750 CESAR CHAVEZ
Practice Address - Street 2:SUITE A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-1138
Practice Address - Country:US
Practice Address - Phone:415-206-9775
Practice Address - Fax:415-206-9640
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:2012-07-30
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
CA052775OtherBLUE CROSS OF CALIFORNIA
CACDC02775GMedicaid
CA05OtherKAISER
CAZZZR0203ZOtherBLUE SHIELD OF CALIFORNIA
CA052775Medicare ID - Type Unspecified