Organization
GREAT FALLS DIALYSIS 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
498 E 30TH ST, PATERSON, NJ 07504-2133
(973) 569-0500
(973) 569-0510
Mailing address
498 E 30TH ST, PATERSON, NJ 07504-2133
(973) 569-0500
(973) 569-0510
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
—
0380229
—
NJ
Enumeration date
03/13/2013
Last updated
01/10/2023
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