Provider Demographics
NPI:1124326517
Name:NEW DIRECTION HOME DIALYSIS LLC
Entity type:Organization
Organization Name:NEW DIRECTION HOME DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-767-6740
Mailing Address - Street 1:4334 NW EXPRESSWAY
Mailing Address - Street 2:SUITE 165
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1515
Mailing Address - Country:US
Mailing Address - Phone:405-767-6740
Mailing Address - Fax:405-767-6741
Practice Address - Street 1:4334 NW EXPRESSWAY
Practice Address - Street 2:SUITE 165
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1515
Practice Address - Country:US
Practice Address - Phone:405-767-6740
Practice Address - Fax:405-767-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment