Provider Demographics
NPI:1306060140
Name:LIBERTY DIALYSIS - DUNELAND LLC
Entity type:Organization
Organization Name:LIBERTY DIALYSIS - DUNELAND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-494-2363
Mailing Address - Street 1:3820 E MERCER WAY
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3806
Mailing Address - Country:US
Mailing Address - Phone:206-236-3255
Mailing Address - Fax:
Practice Address - Street 1:551 SEYMOUR DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304
Practice Address - Country:US
Practice Address - Phone:206-236-3255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment