Provider Demographics
NPI:1629252770
Name:HOME DIALYSIS OF LINCOLN, LLC
Entity Type:Organization
Organization Name:HOME DIALYSIS OF LINCOLN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:KAREL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SYSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-489-5339
Mailing Address - Street 1:7910 O ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2500
Mailing Address - Country:US
Mailing Address - Phone:402-489-5339
Mailing Address - Fax:402-489-7366
Practice Address - Street 1:5355 S 16TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-1277
Practice Address - Country:US
Practice Address - Phone:402-489-5339
Practice Address - Fax:402-489-7366
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIALYSIS CENTER OF LINCOLN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-26
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025826600Medicaid
NE10025826600Medicaid