Healthcare Provider Details

I. General information

NPI: 1902901192
Provider Name (Legal Business Name): HOOD DIALYSIS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 STATE ROUTE 61
MARENGO OH
43334-9215
US

IV. Provider business mailing address

685 N JAMES RD
COLUMBUS OH
43219-1837
US

V. Phone/Fax

Practice location:
  • Phone: 614-235-5361
  • Fax:
Mailing address:
  • Phone: 614-235-5361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberOHL40176
License Number StateOH

VIII. Authorized Official

Name: MS. MELVA HAWKINS
Title or Position: MEMBER
Credential:
Phone: 614-235-5361