Active NPI
Rai Care Centers of Southern California I, LLC
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Garden Grove, CA
National Provider Identifier
1891868519
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Legal business name
- RAI CARE CENTERS OF SOUTHERN CALIFORNIA I, LLC
- Practice address
- 12761 Harbor Blvd
Garden Grove, CA 92840-5800 - Phone
- (714) 539-3122
- Fax
- (714) 539-3922
- NPI assigned
- Nov 17, 2006
- Organization subpart
- Yes
- Parent organization
- FRESENIUS MEDICAL CARE HOLDINGS, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mark R. Fawcett
- Title
- Treasurer
- Phone
- (781) 699-9000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Primary |
Addresses
Primary practice location
12761 Harbor Blvd
Garden Grove, CA 92840-5800
Mailing address
12761 Harbor Blvd.
Garden Grove, CA 92840-5800
Phone (714) 539-3122
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CDC52527G | Medicaid | CA | |
| ZZZR0210Z | Other | CA | BLUE SHIELD OF CALIFORNIA |
| 552527 | Other | CA | BLUE CROSS OF CALIFORNIA |
Other names 1
- RAI-Harbor Blvd.-Garden Grove
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D1017096 | Rai Care Centers of Southern California I, LLC | Certificate of waiver | Sep 15, 2027 |
National Provider Directory
National Provider DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Bristol, TN
- NPI 1477570117
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163721600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1453852800000",
"number": "1891868519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12761 HARBOR BLVD.",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928405800",
"telephone_number": "714-539-3122",
"fax_number": "714-539-3922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12761 HARBOR BLVD",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928405800",
"telephone_number": "714-539-3122",
"fax_number": "714-539-3922"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RAI CARE CENTERS OF SOUTHERN CALIFORNIA I, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FRESENIUS MEDICAL CARE HOLDINGS, INC.",
"enumeration_date": "2006-11-17",
"last_updated": "2016-01-27",
"status": "A",
"authorized_official_last_name": "FAWCETT",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "R.",
"authorized_official_title_or_position": "TREASURER",
"authorized_official_telephone_number": "781-699-9000"
},
"taxonomies": [
{
"code": "261QE0700X",
"taxonomy_group": "",
"desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "CDC52527G",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD OF CALIFORNIA",
"identifier": "ZZZR0210Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF CALIFORNIA",
"identifier": "552527",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "RAI-Harbor Blvd.-Garden Grove",
"code": "5",
"type": "Other Name"
}
]
}
Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.