Provider Demographics
NPI:1497128292
Name:GREATER IRVING II REGIONAL DIALYSIS CENTER LLC
Entity Type:Organization
Organization Name:GREATER IRVING II REGIONAL DIALYSIS CENTER LLC
Other - Org Name:KESSLER PARK REGIONAL 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 1:1070 N WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-2444
Mailing Address - Country:US
Mailing Address - Phone:214-331-7219
Mailing Address - Fax:214-331-7220
Practice Address - Street 1:1070 N WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-2444
Practice Address - Country:US
Practice Address - Phone:214-331-7219
Practice Address - Fax:214-331-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment