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General NPI Number Information
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NPI Number | 1790699395
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Entity Type | Organization
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Legal Business Name | LIBERTY DIALYSIS OPERATIONS LLC
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Dates
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Enumeration Date | 09/30/2026
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Last Update Date | 09/30/2026
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Provider Practice Location Address
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Address Line | 2440 BATON ROUGE
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City | LIMA
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State | OH
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Zip | 45805-5104
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Country | US
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Telephone | 440-298-7168
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Fax |
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Provider Business Mailing Address
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Address Line | 5910 LANDERBROOK DR STE 150
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-6506
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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 | CHIEF OPERATING OFFICER
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Name | JEFFREY DEGYANSKY
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Credential |
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Telephone | 440-298-7168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2472R0900X
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Taxonomy Name | Renal Dialysis Technician
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License Number |
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License Number State | NULL
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