Provider Demographics
NPI:1821540980
Name:FREEDOM CENTER OF HUNTINGTON, LLC
Entity Type:Organization
Organization Name:FREEDOM CENTER OF HUNTINGTON, LLC
Other - Org Name:HUNTINGTON STATION DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP AND TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:33 WALT WHITMAN RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3640
Mailing Address - Country:US
Mailing Address - Phone:631-547-4120
Mailing Address - Fax:631-547-4173
Practice Address - Street 1:33 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3640
Practice Address - Country:US
Practice Address - Phone:631-547-4120
Practice Address - Fax:631-547-4173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment