Provider Demographics
NPI:1548311202
Name:INTERCOMMUNITY DIALYSIS SERVICES
Entity type:Organization
Organization Name:INTERCOMMUNITY DIALYSIS SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DARWISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-696-1841
Mailing Address - Street 1:PO BOX 11065
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-0065
Mailing Address - Country:US
Mailing Address - Phone:562-696-1841
Mailing Address - Fax:562-696-9953
Practice Address - Street 1:12455 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1006
Practice Address - Country:US
Practice Address - Phone:562-696-1841
Practice Address - Fax:562-696-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA052712Medicare Oscar/Certification
CA052712Medicare PIN