Provider Demographics
NPI:1487965869
Name:NORTH EAST KIDNEY CENTER LLC
Entity type:Organization
Organization Name:NORTH EAST KIDNEY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-922-3080
Mailing Address - Street 1:66 CHERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1054
Mailing Address - Country:US
Mailing Address - Phone:978-922-3080
Mailing Address - Fax:978-922-3085
Practice Address - Street 1:7499 PARKLANE RD
Practice Address - Street 2:SUITE 136
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7650
Practice Address - Country:US
Practice Address - Phone:803-741-9912
Practice Address - Fax:803-741-9528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment