NPIMap

Organization Active NPI

San Bernardino Valley Home Dialysis Center, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • San Bernardino, CA
National Provider Identifier
1366469363
Registry record updated May 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
SAN BERNARDINO VALLEY HOME DIALYSIS CENTER, INC.
Practice address
1500 N Waterman Ave
Suite B
San Bernardino, CA 92404-5111
Phone
(909) 381-1595
Fax
(909) 381-3291
NPI assigned
Jul 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Allan G Kavalich, M.D.NPI 1639178692
Title
Ceo - Medical Director
Phone
(909) 381-1595

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

1500 N Waterman Ave
Suite B
San Bernardino, CA 92404-5111

Mailing address

1500 N Waterman Ave
Suite B
San Bernardino, CA 92404-5111
Phone (909) 381-1595

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

End-stage renal disease facility certification: CCN 552565

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SAN BERNARDINO VALLEY HOME DIALYSIS CENTER
Certification status
Active
Provider type (POS)
End-stage renal disease facility
Participating since
Dec 5, 2006
Last certification
Dec 22, 2016
Ownership / control type
For Profit
Facility address
1500 North Waterman Suite B
San Bernardino, CA 92404

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337040000000",
    "number": "1366469363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N WATERMAN AVE",
            "address_2": "SUITE B",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045111",
            "telephone_number": "909-381-1595",
            "fax_number": "909-381-3291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N WATERMAN AVE",
            "address_2": "SUITE B",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045111",
            "telephone_number": "909-381-1595",
            "fax_number": "909-381-3291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN BERNARDINO VALLEY HOME DIALYSIS CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2012-05-15",
        "status": "A",
        "authorized_official_last_name": "KAVALICH",
        "authorized_official_first_name": "ALLAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO - MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "909-381-1595",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.