Provider Demographics
NPI:1922115831
Name:WALTHAM DIALYSIS LLC
Entity Type:Organization
Organization Name:WALTHAM DIALYSIS LLC
Other - Org Name:THE DIALYSIS CENTER AT WALTHAM
Other - Org Type:Doing Business As
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 1:135 BEAVER ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-8412
Mailing Address - Country:US
Mailing Address - Phone:781-642-0331
Mailing Address - Fax:781-642-0332
Practice Address - Street 1:135 BEAVER ST
Practice Address - Street 2:SUITE 111
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8412
Practice Address - Country:US
Practice Address - Phone:781-642-0331
Practice Address - Fax:781-642-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
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
MA1301047Medicaid
MA222568Medicare Oscar/Certification