Provider Demographics
NPI:1881018893
Name:THE DIALYSIS CENTER OF ATTLEBORO LLC
Entity Type:Organization
Organization Name:THE DIALYSIS CENTER OF ATTLEBORO LLC
Other - Org Name:
Other - Org Type:
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 1:217 S MAIN ST
Mailing Address - Street 2:STORE 7
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-4160
Mailing Address - Country:US
Mailing Address - Phone:508-236-6041
Mailing Address - Fax:508-236-6042
Practice Address - Street 1:217 S MAIN ST
Practice Address - Street 2:STORE 7
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-4160
Practice Address - Country:US
Practice Address - Phone:508-236-6041
Practice Address - Fax:508-236-6042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2023-01-11
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
MA222584Medicare Oscar/Certification