MEDICARE: MISSION HILLS DIALYSIS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1821242470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION HILLS DIALYSIS, LLC

Provider Business Mailing Address
First Line	:	11550 INDIAN HILLS RD STE 100
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-1201
Country	:	US
Telephone Number	:	818-898-1724
Fax Number	:	818-365-8348

Provider Business Practice Location Address
First Line	:	11550 INDIAN HILLS RD STE 100
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-1201
Country	:	US
Telephone Number	:	818-898-1724
Fax Number	:	818-365-8348

Authorized Official
Title or Position	:	CFO
Name	:	OMARAN A ABDEEN
Credential	:	MD
Telephone Number	:	818-898-1724

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	06/14/2023

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