Provider Demographics
NPI:1609378165
Name:THE DIALYSIS CENTER OF GARY LLC
Entity Type:Organization
Organization Name:THE DIALYSIS CENTER OF GARY LLC
Other - Org Name:GARY DIALYSIS CENTER
Other - Org Type:Doing Business As
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 1:1705 WEST 25TH AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-3544
Mailing Address - Country:US
Mailing Address - Phone:219-944-0749
Mailing Address - Fax:219-944-0779
Practice Address - Street 1:1705 WEST 25TH AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3544
Practice Address - Country:US
Practice Address - Phone:219-944-0749
Practice Address - Fax:219-944-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment