Provider Demographics
NPI:1073061206
Name:FREEDOM DIALYSIS LLC
Entity Type:Organization
Organization Name:FREEDOM DIALYSIS LLC
Other - Org Name:COMPASS HOME DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-349-3882
Mailing Address - Street 1:940 E HAVERFORD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3845
Mailing Address - Country:US
Mailing Address - Phone:772-349-3882
Mailing Address - Fax:
Practice Address - Street 1:940 E HAVERFORD RD STE 102
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3845
Practice Address - Country:US
Practice Address - Phone:610-520-7277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment