Provider Demographics
NPI:1699861922
Name:ADVANCED DIALYSIS CENTER, LLC
Entity type:Organization
Organization Name:ADVANCED DIALYSIS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MINESSIA
Authorized Official - Middle Name:ZARITA
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:301-943-7808
Mailing Address - Street 1:9320 ANNAPOLIS RD
Mailing Address - Street 2:#200
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706
Mailing Address - Country:US
Mailing Address - Phone:301-577-1007
Mailing Address - Fax:301-577-1006
Practice Address - Street 1:610 DUTCHMANS LANE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601
Practice Address - Country:US
Practice Address - Phone:410-820-9873
Practice Address - Fax:410-820-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDE2642R163WH0500X
261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysisGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
212649Medicare Oscar/Certification