Organization
THE KIDNEY CARE CENTER OF NORTH VALLEY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY GREEN (SECRETARY)
(562) 421-2690
Entity
Organization
Contact information
Practice address
16907 DEVONSHIRE ST, GRANADA HILLS, CA 91344-7407
(818) 366-4600
(818) 366-4606
Mailing address
4000 COVER ST, STE 100, LONG BEACH, CA 90808-1790
(562) 421-2690
(562) 421-2060
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
930000887
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CDC02790F
—
CA
Enumeration date
01/30/2006
Last updated
11/29/2016
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