GOLDENDALE DIALYSIS LLC NPI 1710226915

NPI Information

NPI: 1710226915
Provider Name: GOLDENDALE DIALYSIS LLC

Doing Business As: COLUMBUS HOME TRAINING

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 11D2054582

Address:
1200 BROOKSTONE CENTRE PKWY STE 111
COLUMBUS, GA
ZIP 31904
Phone: (706) 322-2935
Get Directions

GOLDENDALE DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Columbus, GA. GOLDENDALE DIALYSIS LLC NPI is 1710226915. The provider is registered as an organization entity type.
The provider Is Doing Business As Columbus Home Training.

The provider's business location address is:

1200 BROOKSTONE CENTRE PKWY STE 111
COLUMBUS, GA
ZIP 31904-934
Phone: (706) 322-2935
Fax: (706) 317-4862

The provider's authorized official is Samuel Wey .
The authorized official title is Vp Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 11D2054582 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/7/2013 and was last updated on 1/19/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment		GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	003134694A	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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