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General NPI Number Information
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NPI Number | 1689455669
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Entity Type | Organization
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Legal Business Name | PARK TERRACE DIALYSIS, LLC
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Dates
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Enumeration Date | 10/06/2023
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 9700 STONESTREET RD STE B
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City | LOUISVILLE
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State | KY
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Zip | 40272-2884
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Country | US
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Telephone | 502-678-4690
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Fax | 502-678-4691
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Provider Business Mailing Address
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Address Line | 9700 STONESTREET RD STE B
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City | LOUISVILLE
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State | KY
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Zip | 40272-2884
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SVP & CHIEF LEGAL OFFICER
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Name | CRISTINA PIETROWSKI
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Credential |
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Telephone | 502-412-5847
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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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