Organization
HERITAGE DIALYSIS CENTER 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
67 COOPER ST, AGAWAM, MA 01001-2149
(413) 786-2022
(413) 786-2111
Mailing address
67 COOPER ST, AGAWAM, MA 01001-2149
(413) 786-2022
(413) 786-2111
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
—
110085307A
—
MA
Enumeration date
02/03/2009
Last updated
01/10/2023
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