Provider Demographics
NPI:1609020403
Name:LDNL LLC
Entity Type:Organization
Organization Name:LDNL LLC
Other - Org Name:HOPE KIDNEY CLINIC LAKEVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:6410 CRESENT LOOP STE 100
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2087
Mailing Address - Country:US
Mailing Address - Phone:956-717-1600
Mailing Address - Fax:956-717-1601
Practice Address - Street 1:6410 CRESENT LOOP STE 100
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2087
Practice Address - Country:US
Practice Address - Phone:956-717-1600
Practice Address - Fax:956-717-1601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-06
Last Update Date:2023-10-17
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
TX672667Medicare Oscar/Certification