Healthcare Provider Details

I. General information

NPI: 1790699395
Provider Name (Legal Business Name): LIBERTY DIALYSIS OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 BATON ROUGE
LIMA OH
45805-5104
US

IV. Provider business mailing address

5910 LANDERBROOK DR STE 150
MAYFIELD HEIGHTS OH
44124-6506
US

V. Phone/Fax

Practice location:
  • Phone: 440-298-7168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2472R0900X
TaxonomyRenal Dialysis Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEFFREY DEGYANSKY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 440-298-7168