Organization
BROCKTON 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
375 WESTGATE DR, BROCKTON, MA 02301-1818
(508) 586-2791
(508) 583-6986
Mailing address
375 WESTGATE DR, BROCKTON, MA 02301-1818
(508) 586-2791
(508) 583-6986
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
—
110091941A
—
MA
Enumeration date
12/07/2011
Last updated
01/10/2023
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