Provider Demographics
NPI:1942623129
Name:BRAIDWOOD DIALYSIS LLC
Entity Type:Organization
Organization Name:BRAIDWOOD DIALYSIS LLC
Other - Org Name:KIDNEY HOME DOWNTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:HILGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-733-4500
Mailing Address - Street 1:5200 VIRGINIA WAY
Mailing Address - Street 2:L & C DEPARTMENT
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7569
Mailing Address - Country:US
Mailing Address - Phone:615-320-4230
Mailing Address - Fax:866-376-5823
Practice Address - Street 1:200 SAINT PAUL PL
Practice Address - Street 2:SUITE 5
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2004
Practice Address - Country:US
Practice Address - Phone:410-244-5638
Practice Address - Fax:410-244-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment