Provider Demographics
NPI:1912298605
Name:CHOICE HOME DIALYSIS,LLC
Entity Type:Organization
Organization Name:CHOICE HOME DIALYSIS,LLC
Other - Org Name:CHOICE HOME DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-266-9919
Mailing Address - Street 1:350 BUDFIELD ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3214
Mailing Address - Country:US
Mailing Address - Phone:814-254-4262
Mailing Address - Fax:814-254-4323
Practice Address - Street 1:350 BUDFIELD ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3214
Practice Address - Country:US
Practice Address - Phone:814-254-4262
Practice Address - Fax:814-254-4323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2012-07-19
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
PA392775Medicare Oscar/Certification