Provider Demographics
NPI:1205835147
Name:HEMODIALYSIS,INC.
Entity Type:Organization
Organization Name:HEMODIALYSIS,INC.
Other - Org Name:HUNTINGTON DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O./PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DE PALMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-500-8736
Mailing Address - Street 1:710 W WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-2409
Mailing Address - Country:US
Mailing Address - Phone:818-500-8736
Mailing Address - Fax:818-500-7214
Practice Address - Street 1:806 S FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2601
Practice Address - Country:US
Practice Address - Phone:626-792-0548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC02619FMedicaid
CA052619Medicare ID - Type Unspecified