Provider Demographics
NPI:1518229277
Name:KIDNEY CARE CENTERS OF CAMBRIDGE OHIO LLC
Entity Type:Organization
Organization Name:KIDNEY CARE CENTERS OF CAMBRIDGE OHIO LLC
Other - Org Name:
Other - Org Type:
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 1:6901 GLENN HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-8685
Mailing Address - Country:US
Mailing Address - Phone:740-439-1431
Mailing Address - Fax:740-439-1434
Practice Address - Street 1:6901 GLENN HWY
Practice Address - Street 2:SUITE A
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-8685
Practice Address - Country:US
Practice Address - Phone:740-439-1431
Practice Address - Fax:740-439-1434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082929Medicaid
OH362790Medicare Oscar/Certification