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General NPI Number Information
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NPI Number | 1316175326
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Entity Type | Organization
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Legal Business Name | BOARDMAN DIALYSIS CENTER LLC
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 7153 TIFFANY BLVD
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City | BOARDMAN
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State | OH
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Zip | 44514-1965
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Country | US
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Telephone | 330-729-1355
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Fax | 330-729-1377
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Provider Business Mailing Address
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Address Line | 7153 TIFFANY BLVD
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City | YOUNGSTOWN
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State | OH
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Zip | 44514-1965
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Country | US
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Telephone | 330-729-1355
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Fax | 330-729-1377
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Authorized Official
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Title or Position | CHIEF NURSING OFFICER
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Name | SARA ANNE BRADY
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Credential |
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Telephone | 208-371-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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