Provider Demographics
NPI:1528294691
Name:NEPHROLOGY CENTER OF DETROIT LLC
Entity type:Organization
Organization Name:NEPHROLOGY CENTER OF DETROIT LLC
Other - Org Name:<UNAVAIL>
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 1:20001 LIVERNOIS AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-4123
Mailing Address - Country:US
Mailing Address - Phone:313-861-0340
Mailing Address - Fax:313-861-0342
Practice Address - Street 1:20001 LIVERNOIS AVE STE 500
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-4123
Practice Address - Country:US
Practice Address - Phone:313-861-0340
Practice Address - Fax:313-861-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
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
MI1528294691Medicaid
MI232658Medicare Oscar/Certification