Provider Demographics
NPI:1205187903
Name:GRAND PRAIRIE DIALYSIS CENTER LLC
Entity Type:Organization
Organization Name:GRAND PRAIRIE 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 1:550 S CARRIER PKWY
Mailing Address - Street 2:SUITE 450
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1500
Mailing Address - Country:US
Mailing Address - Phone:972-237-2400
Mailing Address - Fax:972-263-3149
Practice Address - Street 1:550 S CARRIER PKWY
Practice Address - Street 2:SUITE 450
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1500
Practice Address - Country:US
Practice Address - Phone:972-237-2400
Practice Address - Fax:972-263-3149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
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
TX315954301Medicaid
TX315954301Medicaid