Provider Demographics
NPI:1477951648
Name:COMMUNITY DIALYSIS CENTER
Entity Type:Organization
Organization Name:COMMUNITY DIALYSIS CENTER
Other - Org Name:CENTER FOR DIALYSIS CARE AT ELIZA BRYANT VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, STRATEGIC PLANNING
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WINTERICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-658-0457
Mailing Address - Street 1:18720 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4855
Mailing Address - Country:US
Mailing Address - Phone:216-658-0457
Mailing Address - Fax:
Practice Address - Street 1:1370 ADDISON ROAD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103
Practice Address - Country:US
Practice Address - Phone:216-658-0457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2016-09-07
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
OH362831Medicare Oscar/Certification