Provider Demographics
NPI:1427647635
Name:HOMEWOOD DIALYSIS CLINIC LLC
Entity type:Organization
Organization Name:HOMEWOOD DIALYSIS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FINGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-766-1995
Mailing Address - Street 1:8028 RITCHIE HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1075
Mailing Address - Country:US
Mailing Address - Phone:410-766-1995
Mailing Address - Fax:410-505-1525
Practice Address - Street 1:2700 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-4300
Practice Address - Country:US
Practice Address - Phone:410-554-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentGroup - Single Specialty