Provider Demographics
NPI:1578224390
Name:LIBERTY DIALYSIS SERVICES INC
Entity Type:Organization
Organization Name:LIBERTY DIALYSIS SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-296-1550
Mailing Address - Street 1:4336 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-1551
Mailing Address - Country:US
Mailing Address - Phone:937-296-1550
Mailing Address - Fax:937-296-1540
Practice Address - Street 1:4336 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-1551
Practice Address - Country:US
Practice Address - Phone:937-296-1550
Practice Address - Fax:937-296-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Single Specialty