Provider Demographics
NPI:1093362618
Name:DIALYSIS CLINIC, INC.
Entity Type:Organization
Organization Name:DIALYSIS CLINIC, INC.
Other - Org Name:DCI-MT. HOPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONOVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-327-3061
Mailing Address - Street 1:1850 PEOPLES AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3607
Mailing Address - Country:US
Mailing Address - Phone:518-271-0702
Mailing Address - Fax:518-271-0624
Practice Address - Street 1:270 MOUNT HOPE DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12202-1058
Practice Address - Country:US
Practice Address - Phone:518-419-6350
Practice Address - Fax:518-419-6349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-19
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment