Provider Demographics
NPI:1083722763
Name:CAPITOL DIALYSIS, LLC
Entity Type:Organization
Organization Name:CAPITOL DIALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-371-7878
Mailing Address - Street 1:140 Q ST NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2101
Mailing Address - Country:US
Mailing Address - Phone:202-636-9411
Mailing Address - Fax:202-636-9415
Practice Address - Street 1:140 Q ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2101
Practice Address - Country:US
Practice Address - Phone:202-636-9411
Practice Address - Fax:202-636-9415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2023-01-10
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
DC017725500Medicaid
MD800303300Medicaid
DC092521Medicare Oscar/Certification