Provider Demographics
NPI:1003815986
Name:HEMODIALYSIS, INC.
Entity Type:Organization
Organization Name:HEMODIALYSIS, INC.
Other - Org Name:GLENDALE HEMODIALYSIS FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O./PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DE PALMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-500-8736
Mailing Address - Street 1:710 W WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2409
Mailing Address - Country:US
Mailing Address - Phone:818-500-8736
Mailing Address - Fax:818-500-7214
Practice Address - Street 1:1560 E CHEVY CHASE DR
Practice Address - Street 2:#160
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4197
Practice Address - Country:US
Practice Address - Phone:818-240-9970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADIA7001FMedicaid
CA052557Medicare ID - Type Unspecified