Provider Demographics
NPI:1982242954
Name:CENTER FOR DIALYSIS CARE BEACHWOOD HOME CARE LLC
Entity type:Organization
Organization Name:CENTER FOR DIALYSIS CARE BEACHWOOD HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEMECEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-658-0458
Mailing Address - Street 1:18720 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4855
Mailing Address - Country:US
Mailing Address - Phone:216-658-0458
Mailing Address - Fax:216-295-7014
Practice Address - Street 1:3755 ORANGE PL STE 103
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4455
Practice Address - Country:US
Practice Address - Phone:216-591-0923
Practice Address - Fax:216-591-0973
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR DIALYSIS CARE HOME CARE, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment