Provider Demographics
NPI:1528815891
Name:FRESENIUS MEDICAL CARE NORTHSHORE HOME, LLC
Entity type:Organization
Organization Name:FRESENIUS MEDICAL CARE NORTHSHORE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:64026 HIGHWAY 434 STE 100
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-5413
Mailing Address - Country:US
Mailing Address - Phone:985-328-6200
Mailing Address - Fax:985-621-4511
Practice Address - Street 1:64026 HIGHWAY 434 STE 100
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-5413
Practice Address - Country:US
Practice Address - Phone:985-328-6200
Practice Address - Fax:985-621-4511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment