Provider Demographics
NPI:1710279674
Name:AT EASE DIALYSIS SUPPORT, LLC
Entity Type:Organization
Organization Name:AT EASE DIALYSIS SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-333-5150
Mailing Address - Street 1:1167 CLEVELAND ST.
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2909
Mailing Address - Country:US
Mailing Address - Phone:267-333-5150
Mailing Address - Fax:
Practice Address - Street 1:1167 CLEVELAND ST.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-2909
Practice Address - Country:US
Practice Address - Phone:267-333-5150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3827564251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health