Provider Demographics
NPI:1316989700
Name:COMMUNITY DIALYSIS CENTERS, INC.
Entity type:Organization
Organization Name:COMMUNITY DIALYSIS CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:RD CDE CSR LDN
Authorized Official - Phone:410-277-9101
Mailing Address - Street 1:2707 N ROLLING RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2157
Mailing Address - Country:US
Mailing Address - Phone:410-277-9101
Mailing Address - Fax:410-277-9001
Practice Address - Street 1:2707 N ROLLING RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2157
Practice Address - Country:US
Practice Address - Phone:410-277-9101
Practice Address - Fax:410-277-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2010-07-14
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
MD404136400Medicaid
MD404136400Medicaid
PA212632Medicare Oscar/Certification