Provider Demographics
NPI:1548671522
Name:REGIONAL DIALYSIS CENTER OF LANCASTER LLC
Entity type:Organization
Organization Name:REGIONAL DIALYSIS CENTER OF LANCASTER 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 1:2500 W PLEASANT RUN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1170
Mailing Address - Country:US
Mailing Address - Phone:972-274-0192
Mailing Address - Fax:972-274-0109
Practice Address - Street 1:2500 W PLEASANT RUN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1170
Practice Address - Country:US
Practice Address - Phone:972-274-0192
Practice Address - Fax:972-274-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2023-01-13
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
TX362414001Medicaid
TX672778Medicare Oscar/Certification