Provider Demographics
NPI:1982777686
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 - EAST OLYMPIC - LOS ANGELES
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 1:5714 E OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90022-5115
Mailing Address - Country:US
Mailing Address - Phone:323-887-0841
Mailing Address - Fax:323-887-8772
Practice Address - Street 1:5714 E OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-5115
Practice Address - Country:US
Practice Address - Phone:323-887-0841
Practice Address - Fax:323-887-8772
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-17
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
CACDC02683HMedicaid
CAZZZR0208ZOtherBLUE SHIELD OF CALIFORNIA
CA052683OtherBLUE CROSS OF CALIFORNIA
CA052683OtherBLUE CROSS OF CALIFORNIA
CA052683OtherBLUE CROSS OF CALIFORNIA