Healthcare Provider Details

I. General information

NPI: 1659309201
Provider Name (Legal Business Name): VACHERIE DIALYSIS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 HWY. 20 SUITE B
VACHERIE LA
70090
US

IV. Provider business mailing address

4424 CONLIN ST SUITE 2A
METAIRIE LA
70006-2147
US

V. Phone/Fax

Practice location:
  • Phone: 225-265-9030
  • Fax: 225-265-7070
Mailing address:
  • Phone: 504-780-1422
  • Fax: 504-780-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number084
License Number StateLA

VIII. Authorized Official

Name: MR. MURAT HATIPOGLU
Title or Position: CEO
Credential:
Phone: 504-780-1422