Organization
THE DIALYSIS CENTER OF WEST PHILADELPHIA LLC
Active
Other names
The Dialysis Center of West Philadelphia at Mill Creek
Organization subpart
No
Provider details
NPI number
Authorized official
SHARI K COUSINS (SR. VP OF CLINICAL & REGULATORY)
(978) 922-3080
Entity
Organization
Contact information
Practice address
4800 BROWN ST STE 201, PHILADELPHIA, PA 19139-2106
(215) 581-4993
(215) 883-1573
Mailing address
4800 BROWN ST, SUITE 201, PHILADELPHIA, PA 19139-2126
(215) 581-4993
(215) 883-1573
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
—
1032188170001
—
PA
Enumeration date
08/26/2015
Last updated
03/11/2020
Update your record
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