Provider Demographics
NPI:1255840427
Name:HOME ADVANTAGE DIALYSIS
Entity Type:Organization
Organization Name:HOME ADVANTAGE DIALYSIS
Other - Org Name:HOME ADVANTAGE DIALYSIS MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-328-6774
Mailing Address - Street 1:1621 44TH ST SW STE 300
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49509-4387
Mailing Address - Country:US
Mailing Address - Phone:512-328-6774
Mailing Address - Fax:512-328-0779
Practice Address - Street 1:1621 44TH ST SW STE 300
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49509-4387
Practice Address - Country:US
Practice Address - Phone:512-328-6774
Practice Address - Fax:512-328-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment