Provider Demographics
NPI:1447292990
Name:DIALYSIS CENTER OF WAKEFIELD LLC
Entity type:Organization
Organization Name:DIALYSIS CENTER OF WAKEFIELD 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 1:10 HIGH ST
Mailing Address - Street 2:SUITES C, D, & E
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3176
Mailing Address - Country:US
Mailing Address - Phone:401-792-3450
Mailing Address - Fax:401-792-3380
Practice Address - Street 1:10 HIGH ST
Practice Address - Street 2:SUITES C, D, & E
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3176
Practice Address - Country:US
Practice Address - Phone:401-792-3450
Practice Address - Fax:401-792-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2023-01-10
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
RIDC61454Medicaid
RIDC61454Medicaid