Provider Demographics
NPI:1184853855
Name:WOODHAVEN DIALYSIS CENTER LLC
Entity Type:Organization
Organization Name:WOODHAVEN 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 1:1336 BRISTOL PIKE STE 110
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5660
Mailing Address - Country:US
Mailing Address - Phone:215-639-1070
Mailing Address - Fax:215-639-1270
Practice Address - Street 1:1336 BRISTOL PIKE STE 110
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5660
Practice Address - Country:US
Practice Address - Phone:215-639-1070
Practice Address - Fax:215-639-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2023-01-13
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
PA1024238220001Medicaid
PA392773Medicare Oscar/Certification