Provider Demographics
NPI:1093854622
Name:LIBERTY DIALYSIS-NORTH HAWAII LLC
Entity Type:Organization
Organization Name:LIBERTY DIALYSIS-NORTH HAWAII LLC
Other - Org Name:LIBERTY DIALYSIS - NORTH HAWAII, LLC
Other - Org Type:Doing Business As
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 1:67-1123 MAMALAHOA HWY STE 112
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8451
Mailing Address - Country:US
Mailing Address - Phone:808-930-2001
Mailing Address - Fax:808-885-1506
Practice Address - Street 1:67-1123 MAMALAHOA HWY STE 112
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8451
Practice Address - Country:US
Practice Address - Phone:808-930-2001
Practice Address - Fax:808-885-1506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-06
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
HI122519Medicare Oscar/Certification