Organization
THE KIDNEY CARE CENTER OF NORTH VALLEY, INC.
Active
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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