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General NPI Number Information
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NPI Number | 1437246063
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Entity Type | Organization
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Legal Business Name | COMMUNITY DIALYSIS CENTER
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 8900 TYLER BLVD
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City | MENTOR
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State | OH
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Zip | 44060-2185
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Country | US
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Telephone | 440-951-3602
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Fax | 440-255-7581
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Provider Business Mailing Address
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Address Line | 18720 CHAGRIN BLVD
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-4855
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Country | US
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Telephone | 216-295-7003
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Fax | 216-295-7014
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Authorized Official
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Title or Position | COO
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Name | GAYLE A NEMECEK
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Credential |
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Telephone | 216-658-0458
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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 | 0639DC
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License Number State | OH
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