Provider Demographics
NPI:1376777144
Name:HAPEVILLE DIALYSIS CENTER LLC
Entity Type:Organization
Organization Name:HAPEVILLE DIALYSIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-762-9333
Mailing Address - Street 1:1136 CLEVELAND AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3618
Mailing Address - Country:US
Mailing Address - Phone:404-762-9333
Mailing Address - Fax:404-762-9334
Practice Address - Street 1:800 VIRGINIA AVE
Practice Address - Street 2:#100
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-4302
Practice Address - Country:US
Practice Address - Phone:404-762-9333
Practice Address - Fax:404-762-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2010-12-13
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
GA112822Medicare Oscar/Certification