MEDICARE: COMMUNITY DIALYSIS CENTERS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316989700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY DIALYSIS CENTERS, INC.

Provider Business Mailing Address
First Line	:	2707 N ROLLING RD
Second Line	:	SUITE 104
City	:	WINDSOR MILL
State	:	MD
Zip	:	21244-2157
Country	:	US
Telephone Number	:	410-277-9101
Fax Number	:	410-277-9001

Provider Business Practice Location Address
First Line	:	2707 N ROLLING RD
Second Line	:	SUITE 104
City	:	WINDSOR MILL
State	:	MD
Zip	:	21244-2157
Country	:	US
Telephone Number	:	410-277-9101
Fax Number	:	410-277-9001

Authorized Official
Title or Position	:	OPERATIONS COORDINATOR
Name	:	SHANNON GREEN
Credential	:	RD CDE CSR LDN
Telephone Number	:	410-277-9101

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/14/2010

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