Provider Demographics
NPI:1497481360
Name:WATERFORD DIALYSIS LLC
Entity Type:Organization
Organization Name:WATERFORD DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP & CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIETROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-412-5847
Mailing Address - Street 1:PO BOX 221648
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-1648
Mailing Address - Country:US
Mailing Address - Phone:502-412-5847
Mailing Address - Fax:
Practice Address - Street 1:800 ST. JOSEPH DRIVE
Practice Address - Street 2:DIALYSIS CLINIC
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-1983
Practice Address - Country:US
Practice Address - Phone:765-236-1239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY DIALYSIS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment