Provider Demographics
NPI:1417221185
Name:WESTHAMPTON REGIONAL DIALYSIS CENTER LLC
Entity Type:Organization
Organization Name:WESTHAMPTON REGIONAL DIALYSIS CENTER LLC
Other - Org Name:RACEWAY 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 1:500 E LABURNUM AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-2123
Mailing Address - Country:US
Mailing Address - Phone:804-228-9990
Mailing Address - Fax:804-228-9998
Practice Address - Street 1:500 E LABURNUM AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23222-2123
Practice Address - Country:US
Practice Address - Phone:804-228-9990
Practice Address - Fax:804-228-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2023-01-14
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
VA492664Medicare Oscar/Certification