TOTAL RENAL CARE INC NPI 1659525590

NPI Information

NPI: 1659525590
Provider Name: TOTAL RENAL CARE INC

Doing Business As: VILLA OF GREAT NORTHERN

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
22710 FAIRVIEW CENTER DR
STE 100
FAIRVIEW PARK, OH
ZIP 44126
Phone: (440) 734-4630
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TOTAL RENAL CARE INC is an end-stage renal disease (esrd) treatment clinic center in Fairview Park, OH. TOTAL RENAL CARE INC NPI is 1659525590. The provider is registered as an organization entity type.
The provider Is Doing Business As Villa Of Great Northern.

The provider's business location address is:

22710 FAIRVIEW CENTER DR
STE 100
FAIRVIEW PARK, OH
ZIP 44126-607
Phone: (440) 734-4630
Fax: (440) 734-4659

The provider's authorized official is Samuel T Wey .
The authorized official title is Vp Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 36D1091674 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/5/2008 and was last updated on 2/6/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3041014	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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