Provider Demographics
NPI:1457829269
Name:VALLEY HOME DIALYSIS
Entity Type:Organization
Organization Name:VALLEY HOME DIALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-933-0319
Mailing Address - Street 1:3821 MASTHEAD ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4679
Mailing Address - Country:US
Mailing Address - Phone:505-933-0319
Mailing Address - Fax:
Practice Address - Street 1:3900 E LOHMAN AVE STE B1
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8268
Practice Address - Country:US
Practice Address - Phone:505-933-0319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentGroup - Single Specialty