Organization
WALLINGFORD DIALYSIS CARE 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
720 N MAIN STREET EXT STE 3, WALLINGFORD, CT 06492-2788
(203) 265-0667
(203) 265-0669
Mailing address
720 N MAIN STREET EXT STE 3, WALLINGFORD, CT 06492-2788
(203) 265-0667
(203) 265-0669
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
—
8063906
—
CT
Enumeration date
04/29/2015
Last updated
01/10/2023
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