Active NPI
The Kidney Care Center of North Valley, Inc.
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Granada Hills, CA
National Provider Identifier
1699746396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- License
- 930000887
- Legal business name
- THE KIDNEY CARE CENTER OF NORTH VALLEY, INC.
- Practice address
- 16907 Devonshire St
Granada Hills, CA 91344-7407 - Phone
- (818) 366-4600
- Fax
- (818) 366-4606
- NPI assigned
- Jan 30, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jerry Green
- Title
- Secretary
- Phone
- (562) 421-2690
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 930000887 | CA | Primary |
Addresses
Primary practice location
16907 Devonshire St
Granada Hills, CA 91344-7407
Mailing address
4000 Cover St
Ste 100
Long Beach, CA 90808-1790
Phone (562) 421-2690
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CDC02790F | Medicaid | CA |
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 052790
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
- THE KIDNEY CENTER OF THE NORTH VALLEY
- Certification status
- Active
- Provider type (POS)
- End-stage renal disease facility
- Participating since
- Jul 24, 1996
- Last certification
- Jun 29, 2022
- Ownership / control type
- For Profit
- Multi-facility organization
- NATIONAL RENAL CARE LLC
- Facility address
- 16907 Devonshire
Granada Hills, CA 91344
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138579200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1480377600000",
"number": "1699746396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4000 COVER ST",
"address_2": "STE 100",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908081790",
"telephone_number": "562-421-2690",
"fax_number": "562-421-2060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16907 DEVONSHIRE ST",
"city": "GRANADA HILLS",
"state": "CA",
"postal_code": "913447407",
"telephone_number": "818-366-4600",
"fax_number": "818-366-4606"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THE KIDNEY CARE CENTER OF NORTH VALLEY, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-01-30",
"last_updated": "2016-11-29",
"status": "A",
"authorized_official_last_name": "GREEN",
"authorized_official_first_name": "JERRY",
"authorized_official_title_or_position": "SECRETARY",
"authorized_official_telephone_number": "562-421-2690",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261QE0700X",
"taxonomy_group": "",
"desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
"state": "CA",
"license": "930000887",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "CDC02790F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Granada Hills, CA
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.