Provider Demographics
NPI:1114085990
Name:CENTRAL KITTANNING DIALYSIS CENTER LLC
Entity Type:Organization
Organization Name:CENTRAL KITTANNING DIALYSIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:
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 1:1 NOLTE DR
Mailing Address - Street 2:SUITE 720
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7111
Mailing Address - Country:US
Mailing Address - Phone:724-543-3151
Mailing Address - Fax:724-543-4727
Practice Address - Street 1:1 NOLTE DRIVE
Practice Address - Street 2:SUITE 720
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7111
Practice Address - Country:US
Practice Address - Phone:724-543-3151
Practice Address - Fax:724-543-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
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
PA1018397950001Medicaid
PA1018397950001Medicaid