Provider Demographics
NPI:1669842696
Name:THE DIALYSIS UNIT OF CENTER CITY PHILADELPHIA LLC
Entity Type:Organization
Organization Name:THE DIALYSIS UNIT OF CENTER CITY PHILADELPHIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VP OF CLINICAL & REGULATORY
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:K
Authorized Official - Last Name:COUSINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-922-3080
Mailing Address - Street 1:230 N BROAD ST
Mailing Address - Street 2:12 FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1121
Mailing Address - Country:US
Mailing Address - Phone:215-563-9383
Mailing Address - Fax:215-563-9429
Practice Address - Street 1:230 N BROAD ST
Practice Address - Street 2:12 FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1121
Practice Address - Country:US
Practice Address - Phone:215-563-9383
Practice Address - Fax:215-563-9429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2020-03-16
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
PA1030987550001Medicaid
PA1030987550001Medicaid