Organization Name: | DAVITA - RIVERSIDE LLC |
NPI Number: | 1205895869 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES K HILGER (CHIEF ACCOUNTING OFFICER) |
Mailing Address: | 32291 Mission Trl Bldg S Lake Elsinore |
State: | CA US |
Postal Code: | 925304524 |
Phone Number: | 9516745050 |
Fax Number: | 9516745570 |
NPI Enumeration Date: | 03/22/2006 |
NPI Last Update Date: | 05/31/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | 240000841 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |