Organization
DESOTO REGIONAL DIALYSIS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA ANNE BRADY (CHIEF NURSING OFFICER)
(208) 371-7878
Entity
Organization
Contact information
Practice address
2651 BOLTON BOONE DR, BUILDING B, DESOTO, TX 75115-2011
(972) 780-5991
(972) 780-5992
Mailing address
2651 BOLTON BOONE DR, BUILDING B, DESOTO, TX 75115-2011
(972) 780-5991
(972) 780-5992
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
364692901
—
TX
Enumeration date
05/13/2014
Last updated
01/13/2023
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