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
455 TURNER RD, DAYTON, OH 45415-3630
(937) 499-8850
(937) 223-9615
Mailing address
136 S. LUDLOW ST., SUITE 500, DAYTON, OH 45402
(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
—
000000065135
BLUE CROSS/BLUE SHIELD
OH
05
—
2178665
—
OH
01
—
39544
CARESOURCE
OH
01
—
6800128
UNITED HEALTHCARE
OH
Enumeration date
11/14/2005
Last updated
08/29/2012
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