Provider Demographics
NPI:1225704125
Name:BRABURRY DIALYSIS LLC
Entity Type:Organization
Organization Name:BRABURRY DIALYSIS LLC
Other - Org Name:SOUTH EDISON DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINSTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-733-4501
Mailing Address - Street 1:5200 VIRGINIA WAY
Mailing Address - Street 2:L AND C DEPT
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7569
Mailing Address - Country:US
Mailing Address - Phone:615-320-4414
Mailing Address - Fax:866-865-2884
Practice Address - Street 1:561 US HIGHWAY 1
Practice Address - Street 2:PAD H
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4400
Practice Address - Country:US
Practice Address - Phone:908-332-0239
Practice Address - Fax:908-332-0259
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVITA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-19
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment