Provider Demographics
NPI:1508029372
Name:ADVANCED DIALYSIS CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED DIALYSIS CENTER, LLC
Other - Org Name:ADVANCED DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:HAYES
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:202-422-7492
Mailing Address - Street 1:9320 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3100
Mailing Address - Country:US
Mailing Address - Phone:301-577-1007
Mailing Address - Fax:301-577-1006
Practice Address - Street 1:299 HURLEY AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3118
Practice Address - Country:US
Practice Address - Phone:301-577-1007
Practice Address - Fax:301-577-1006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED DIALYSIS CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-02
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDE2656261QE0700X
261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406877700Medicaid
MD406877700Medicaid