Provider Demographics
NPI:1811095722
Name:ADVANCED DIALYSIS CENTER, LLC
Entity type:Organization
Organization Name:ADVANCED DIALYSIS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINESSIA
Authorized Official - Middle Name:ZARITA
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:301-577-1007
Mailing Address - Street 1:9320 ANNAPOLIS RD
Mailing Address - Street 2:#200 ADVANCED DIALYSIS CENTER POTOMAC
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706
Mailing Address - Country:US
Mailing Address - Phone:301-577-1007
Mailing Address - Fax:301-577-1006
Practice Address - Street 1:1785 N HAYES STREET
Practice Address - Street 2:ADVANCED DIALYSIS CENTER POTOMAC
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202
Practice Address - Country:US
Practice Address - Phone:703-521-1056
Practice Address - Fax:703-521-1058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDE2642R163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysisGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
492635Medicare Oscar/Certification