Provider Demographics
NPI:1235311051
Name:DIALYSIS CENTER OF WESTERN MASSACHUSETTS LLC
Entity type:Organization
Organization Name:DIALYSIS CENTER OF WESTERN MASSACHUSETTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-371-7878
Mailing Address - Street 1:601 MEMORIAL DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-5068
Mailing Address - Country:US
Mailing Address - Phone:413-593-3078
Mailing Address - Fax:413-593-1978
Practice Address - Street 1:601 MEMORIAL DR
Practice Address - Street 2:SUITE H
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-5068
Practice Address - Country:US
Practice Address - Phone:413-593-3078
Practice Address - Fax:413-593-1978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1304861Medicaid
MA1304861Medicaid