Provider Demographics
NPI:1689455669
Name:PARK TERRACE DIALYSIS, LLC
Entity Type:Organization
Organization Name:PARK TERRACE DIALYSIS, LLC
Other - Org Name:TRILOGY DIALYSIS - PARK TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIETROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-412-5847
Mailing Address - Street 1:9700 STONESTREET RD STE B
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-2884
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9700 STONESTREET RD STE B
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-2884
Practice Address - Country:US
Practice Address - Phone:502-678-4690
Practice Address - Fax:502-678-4691
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY INVESTORS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment