Provider Demographics
NPI:1588758239
Name:RAI CARE CENTERS OF ILLINOIS I, LLC
Entity type:Organization
Organization Name:RAI CARE CENTERS OF ILLINOIS I, LLC
Other - Org Name:<UNAVAIL>
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 1:124 REGENCY PARK DRIVE STE 1
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1994
Mailing Address - Country:US
Mailing Address - Phone:618-622-0634
Mailing Address - Fax:618-622-0668
Practice Address - Street 1:124 REGENCY PARK DRIVE STE 1
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1994
Practice Address - Country:US
Practice Address - Phone:618-622-0634
Practice Address - Fax:618-622-0668
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL142558Medicare Oscar/Certification