Provider Demographics
NPI:1871184432
Name:CENLA DIALYSIS CARE LLC
Entity Type:Organization
Organization Name:CENLA DIALYSIS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRACHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-641-5614
Mailing Address - Street 1:2220 WORLEY DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3600
Mailing Address - Country:US
Mailing Address - Phone:318-704-0001
Mailing Address - Fax:318-704-0002
Practice Address - Street 1:1430 W ELM ST
Practice Address - Street 2:
Practice Address - City:JENA
Practice Address - State:LA
Practice Address - Zip Code:71342-4800
Practice Address - Country:US
Practice Address - Phone:318-704-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentGroup - Single Specialty