Provider Demographics
NPI:1790401677
Name:AT HOME DIALYSIS, LLC
Entity Type:Organization
Organization Name:AT HOME DIALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GUNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAHROMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-500-8147
Mailing Address - Street 1:340 E COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-2017
Mailing Address - Country:US
Mailing Address - Phone:657-500-8147
Mailing Address - Fax:866-735-9057
Practice Address - Street 1:340 E COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-2017
Practice Address - Country:US
Practice Address - Phone:657-500-8147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment