MEDICARE: COMMUNITY DIALYSIS CENTER

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	0368DC	OH

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	:	1568559128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY DIALYSIS CENTER

Provider Business Mailing Address
First Line	:	18720 CHAGRIN BLVD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-4855
Country	:	US
Telephone Number	:	216-295-7003
Fax Number	:	216-295-7014

Provider Business Practice Location Address
First Line	:	3330 W 25TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-1614
Country	:	US
Telephone Number	:	216-741-5776
Fax Number	:	216-741-5467

Authorized Official
Title or Position	:	COO
Name	:	GAYLE A NEMECEK
Credential	:
Telephone Number	:	216-658-0458

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	03/03/2025

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Directions to “COMMUNITY DIALYSIS CENTER ” Practice Location

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