=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396283339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OAKLAND DIALYSIS CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2017
-----------------------------------------------------
Last Update Date | 01/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3250 N STATE ROAD 7 REEF PLAZA
-----------------------------------------------------
City | LAUDERDALE LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33319-5615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-717-2293
-----------------------------------------------------
Fax | 954-717-4128
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3250 N STATE ROAD 7 REEF PLAZA
-----------------------------------------------------
City | LAUDERDALE LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33319-5615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-717-2293
-----------------------------------------------------
Fax | 954-717-4128
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF NURSING OFFICER
-----------------------------------------------------
Name | SARA ANNE BRADY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 208-371-7878
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------