1396148540 NPI number — HARRIMAN DIALYSIS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396148540 NPI number — HARRIMAN DIALYSIS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARRIMAN DIALYSIS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FRIENDLY FARMS HOME DIALYSIS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396148540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 VIRGINIA WAY
Provider Second Line Business Mailing Address:
L&C DEPARTMENT
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-7569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-320-4214
Provider Business Mailing Address Fax Number:
866-944-3352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10905 FORT WASHINGTON RD
Provider Second Line Business Practice Location Address:
STE 307
Provider Business Practice Location Address City Name:
FORT WASHINGTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20744-5843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-292-0540
Provider Business Practice Location Address Fax Number:
301-292-3493
Provider Enumeration Date:
10/02/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WINSTEL
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ACCOUNTING OFFICER
Authorized Official Telephone Number:
253-733-4501

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  E2714 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2000989 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: E2714 . This is a "STATE LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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