Provider Demographics
NPI:1821242470
Name:MISSION HILLS DIALYSIS, LLC
Entity Type:Organization
Organization Name:MISSION HILLS DIALYSIS, LLC
Other - Org Name:MISSION HILLS DIALYSIS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:OMARAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-898-1724
Mailing Address - Street 1:11550 INDIAN HILLS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1201
Mailing Address - Country:US
Mailing Address - Phone:818-898-1724
Mailing Address - Fax:818-365-8348
Practice Address - Street 1:11550 INDIAN HILLS RD STE 100
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1201
Practice Address - Country:US
Practice Address - Phone:818-898-1724
Practice Address - Fax:818-365-8348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2023-06-14
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
CACDC70048GMedicaid
CACDC70048GMedicaid