Provider Demographics
NPI:1770062663
Name:THE DIALYSIS CENTER OF VALPARAISO LLC
Entity type:Organization
Organization Name:THE DIALYSIS CENTER OF VALPARAISO LLC
Other - Org Name:<UNAVAIL>
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 1:2711 LEONARD DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-7121
Mailing Address - Country:US
Mailing Address - Phone:219-462-1233
Mailing Address - Fax:219-462-1234
Practice Address - Street 1:2711 LEONARD DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-462-1233
Practice Address - Fax:219-462-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment