Provider Demographics
NPI:1154418721
Name:THE CENTER FOR DIALYSIS CARE AT HEATHER HILL
Entity type:Organization
Organization Name:THE CENTER FOR DIALYSIS CARE AT HEATHER HILL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEMECEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-658-0458
Mailing Address - Street 1:18720 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4855
Mailing Address - Country:US
Mailing Address - Phone:216-295-7003
Mailing Address - Fax:216-295-7014
Practice Address - Street 1:12340 BASS LAKE RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-8327
Practice Address - Country:US
Practice Address - Phone:440-286-4103
Practice Address - Fax:440-286-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0488DC261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2143639Medicaid
OH2143639Medicaid