Provider Demographics
NPI:1275991531
Name:THE DIALYSIS CENTER OF SCHERERVILLE LLC
Entity Type:Organization
Organization Name:THE DIALYSIS CENTER OF SCHERERVILLE LLC
Other - Org Name:SCHERERVILLE DIALYSIS CENTER
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 1:1534 US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1316
Mailing Address - Country:US
Mailing Address - Phone:219-322-5448
Mailing Address - Fax:219-322-5315
Practice Address - Street 1:1534 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1316
Practice Address - Country:US
Practice Address - Phone:219-322-5448
Practice Address - Fax:219-322-5315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2023-01-13
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
IN152670Medicare Oscar/Certification