Organization
TOTAL RENAL CARE INC
Active
Other names
State Fair Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
19800 WOODWARD AVE, DETROIT, MI 48203-5102
(313) 893-8610
(313) 893-8865
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPARTMENT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285942409
—
MI
Enumeration date
09/22/2010
Last updated
04/29/2024
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