Provider Demographics
NPI:1659770394
Name:ONTARIO HOLT DIALYSIS CENTER, INC.
Entity Type:Organization
Organization Name:ONTARIO HOLT DIALYSIS CENTER, INC.
Other - Org Name:POMONA ONTARIO DIALYSIS CENTER, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YASEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-542-2900
Mailing Address - Street 1:1335 CYPRESS STREET,
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773
Mailing Address - Country:US
Mailing Address - Phone:909-542-2900
Mailing Address - Fax:909-592-6000
Practice Address - Street 1:1310 W HOLT BLVD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3640
Practice Address - Country:US
Practice Address - Phone:909-542-2900
Practice Address - Fax:909-592-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center