Provider Demographics
NPI:1710460548
Name:HUNT COUNTY REGIONAL DIALYSIS CENTER LLC
Entity Type:Organization
Organization Name:HUNT COUNTY REGIONAL DIALYSIS CENTER LLC
Other - Org Name:HUNT COUNTY DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-371-7878
Mailing Address - Street 1:3301 RIDGECREST RD STE 1
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6251
Mailing Address - Country:US
Mailing Address - Phone:903-455-0579
Mailing Address - Fax:903-455-0586
Practice Address - Street 1:3301 RIDGECREST RD STE 1
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6251
Practice Address - Country:US
Practice Address - Phone:903-455-0579
Practice Address - Fax:903-455-0586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment