Provider Demographics
NPI:1891248365
Name:CLARION DIALYSIS CENTER, LLC
Entity Type:Organization
Organization Name:CLARION DIALYSIS CENTER, LLC
Other - Org Name:CLARION DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:22631 ROUTE 68 STE 450
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-4076
Mailing Address - Country:US
Mailing Address - Phone:814-223-4655
Mailing Address - Fax:814-223-4658
Practice Address - Street 1:22631 ROUTE 68 STE 450
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-4076
Practice Address - Country:US
Practice Address - Phone:814-223-4655
Practice Address - Fax:814-223-4658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2024-02-02
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
PA1032305260001Medicaid
PA1032305260001Medicaid