Provider Demographics
NPI:1467847202
Name:KERMAN DIALYSIS CENTER LLC
Entity type:Organization
Organization Name:KERMAN DIALYSIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-371-7878
Mailing Address - Street 1:14945 W WHITESBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:KERMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93630-1111
Mailing Address - Country:US
Mailing Address - Phone:559-846-0023
Mailing Address - Fax:559-846-0024
Practice Address - Street 1:14945 W WHITESBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1111
Practice Address - Country:US
Practice Address - Phone:559-846-0023
Practice Address - Fax:559-846-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2023-01-10
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
CA552797Medicare Oscar/Certification