GRAND HOME DIALYSIS LLC NPI 1780863878

NPI Information

NPI: 1780863878
Provider Name: GRAND HOME DIALYSIS LLC

Doing Business As: GRAND HOME DIALYSIS

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
14671 W MOUNTAIN VIEW BLVD
STE 106
SURPRISE, AZ
ZIP 85374
Phone: (623) 546-6120
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GRAND HOME DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Surprise, AZ. GRAND HOME DIALYSIS LLC NPI is 1780863878. The provider is registered as an organization entity type.
The provider Is Doing Business As Grand Home Dialysis.

The provider's business location address is:

14671 W MOUNTAIN VIEW BLVD
STE 106
SURPRISE, AZ
ZIP 85374-840
Phone: (623) 546-6120
Fax: (623) 546-2693

The provider's authorized official is John D Winstel .
The authorized official title is Chief Accounting Officer and has the following contact phone number (253) 733-4501.

The CLIA number assigned to this NPI record is 03D1076614 - end stage renal disease dialysis with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/25/2007 and was last updated on 1/14/2022.

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			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	633472	MEDICAID	ARIZONA

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: 11/14/2023

NPI Synchronization or Removal

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