Ultimate Renal Care, LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

E2614 Issued in MD

Legal business name

ULTIMATE RENAL CARE, LLC

Practice address

2426 Chillum Rd
Hyattsville, MD 20782-3629

Phone

(301) 927-8808

Fax

(301) 927-8809

NPI assigned

Oct 2, 2006

Organization subpart

No

Name

Mr. Juan Gumabon Canlas

Title

Administrator

Phone

(301) 927-8808

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 16, 2007.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187222400000",
    "number": "1134212970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2426 CHILLUM RD",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207823629",
            "telephone_number": "301-927-8808",
            "fax_number": "301-927-8809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2426 CHILLUM RD",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207823629",
            "telephone_number": "301-927-8808",
            "fax_number": "301-927-8809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULTIMATE RENAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2007-08-16",
        "status": "A",
        "authorized_official_last_name": "CANLAS",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "GUMABON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "301-927-8808",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MD",
            "license": "E2614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Hyattsville, MD
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.