=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902901192
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOOD DIALYSIS SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 827 STATE ROUTE 61
-----------------------------------------------------
City | MARENGO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43334-9215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-235-5361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 685 N JAMES RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43219-1837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-235-5361
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | MS. MELVA HAWKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-235-5361
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number | OHL40176
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------