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Organization

DIALYSIS CENTERS OF DAYTON, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JAYME NICOLE HANSEN (CONTROLLER)
(937) 499-8850
Entity
Organization

Contact information

Practice address
4700 SPRINGBORO PIKE, MORAINE, OH 45439-1964
(937) 499-8850
(937) 223-9615
Mailing address
136 S LUDLOW ST, SUITE 500, DAYTON, OH 45402-1813
(937) 499-8850
(937) 223-9615

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
01
000000002892
BLUE CROSS/BLUE SHIELD
OH
01
13791
CARESOURCE
OH
05
2178638
OH
01
6820003
UNITED HEALTHCARE
OH
Enumeration date
11/14/2005
Last updated
08/29/2012
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