Organization
LEESVILLE DIALYSIS CENTER, LLC
Active
Other names
Leesville Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES J DIVITO (VICE PRESIDENT)
(781) 699-9000
Entity
Organization
Contact information
Practice address
900 N 5TH ST STE 5, LEESVILLE, LA 71446-3530
(337) 392-5122
(337) 392-1192
Mailing address
900 N 5TH ST STE 5, LEESVILLE, LA 71446-3530
(337) 392-5122
(337) 392-1192
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
—
1193062
—
LA
Enumeration date
03/21/2007
Last updated
11/16/2020
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