Provider Demographics
NPI:1023599784
Name:AMERICAN DIALYSIS CENTERS, NORTH LAS VEGAS LLC
Entity type:Organization
Organization Name:AMERICAN DIALYSIS CENTERS, NORTH LAS VEGAS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:OVUWORIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-232-1186
Mailing Address - Street 1:900 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-6425
Mailing Address - Country:US
Mailing Address - Phone:702-383-9741
Mailing Address - Fax:702-387-1145
Practice Address - Street 1:4107 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-3476
Practice Address - Country:US
Practice Address - Phone:702-383-9741
Practice Address - Fax:702-387-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment