Provider Demographics
NPI:1235854399
Name:LIBERTY DIALYSIS-HAWAII, LLC
Entity Type:Organization
Organization Name:LIBERTY DIALYSIS-HAWAII, LLC
Other - Org Name:FRESENIUS KIDNEY CARE HILO LANIKAULA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:85 W LANIKAULA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4199
Mailing Address - Country:US
Mailing Address - Phone:808-480-3640
Mailing Address - Fax:808-490-6127
Practice Address - Street 1:85 W LANIKAULA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4199
Practice Address - Country:US
Practice Address - Phone:808-480-3640
Practice Address - Fax:808-490-6127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-11
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment