Provider Demographics
NPI:1215372487
Name:WESTMINSTER RENAL DIALYSIS LLC
Entity Type:Organization
Organization Name:WESTMINSTER RENAL DIALYSIS LLC
Other - Org Name:KIDNEY CENTER OF NORTHRIDGE
Other - Org Type:Doing Business As
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 1:1865 W 121ST AVE
Mailing Address - Street 2:SUITE 300-C
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2326
Mailing Address - Country:US
Mailing Address - Phone:303-429-9550
Mailing Address - Fax:303-429-9540
Practice Address - Street 1:1865 W 121ST AVE
Practice Address - Street 2:SUITE 300-C
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2326
Practice Address - Country:US
Practice Address - Phone:303-429-9550
Practice Address - Fax:303-429-9540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
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
CO20375271Medicaid
CO20375271Medicaid