Provider Demographics
NPI:1972544765
Name:PASADENA DIALYSIS, LLC
Entity type:Organization
Organization Name:PASADENA DIALYSIS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:1111 S ARROYO PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3217
Mailing Address - Country:US
Mailing Address - Phone:626-441-9500
Mailing Address - Fax:626-441-9502
Practice Address - Street 1:1111 S ARROYO PKWY STE 150
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3217
Practice Address - Country:US
Practice Address - Phone:626-441-9500
Practice Address - Fax:626-441-9502
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-10
Last Update Date:2023-10-24
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
CACDC52517FMedicaid
CACDC52517FOtherCALIFORNIA CHILDREN'S SER
CACDC52517FOtherCALIFORNIA CHILDREN'S SER