Provider Demographics
NPI:1447986658
Name:CDI HEALTH PEORIA DIALYSIS LLC
Entity type:Organization
Organization Name:CDI HEALTH PEORIA DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATIONAL DIR. BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:361-548-8791
Mailing Address - Street 1:1717 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4773
Mailing Address - Country:US
Mailing Address - Phone:512-599-8022
Mailing Address - Fax:
Practice Address - Street 1:13215 N 94TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4838
Practice Address - Country:US
Practice Address - Phone:512-599-8022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment