Provider Demographics
NPI:1154638013
Name:AMERICAN HOME DIALYSIS, LLC
Entity Type:Organization
Organization Name:AMERICAN HOME DIALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAI
Authorized Official - Middle Name:P
Authorized Official - Last Name:BHIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-523-4535
Mailing Address - Street 1:234 E GRAY ST
Mailing Address - Street 2:SUITE 858
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1927
Mailing Address - Country:US
Mailing Address - Phone:513-673-5245
Mailing Address - Fax:866-352-4339
Practice Address - Street 1:234 E GRAY ST
Practice Address - Street 2:SUITE 858
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1927
Practice Address - Country:US
Practice Address - Phone:513-673-5245
Practice Address - Fax:866-352-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY300225261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY182612Medicare Oscar/Certification