NORTHWEST DETROIT DIALYSIS CENTER LLC (NPI# 1083634463) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083634463 |
| Entity Type | Organization |
| Organization Name | NORTHWEST DETROIT DIALYSIS CENTER LLC |
| Practice Address |
25664 Lahser Rd Southfield MI 48033-5810 |
| Mailing Address |
30100 Telegraph Rd Suite 200 Bingham Farms MI 48025-4516 |
| Practice Telephone | 2483587521 |
| Practice Fax Number | 2483587522 |
| Mailing Telephone | 2487230224 |
| Mailing Fax Number | 2486427852 |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2012-10-15 |
| Authorized Official Name | MR. DAVID F SHEPHERD (VICE PRESIDENT) |
| Authorized Official Telephone | 2486425038 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FED BLUE CROSS PRIMARY | D8956 | 01 | |
| FED BLUE CROSS SECONDARY | D9466 | 01 | |
| WELLNESS | 10078540001 | 01 | |
| MI | 4568218 | 05 | |
| BLUE CARE NETWORK | P09457 | 01 | |
| BLUE CROSS SECONDARY | D9466 | 01 | |
| CARE CHOICES | 138129 | 01 | |
| HAP | 232544 | 01 | |
| GREATLAKES | 5066 | 01 | |
| PREFERRED CHOICE | 138129 | 01 | |
| M CARE | 14296 | 01 | |
| BLUE CROSS PRIMARY | D8956 | 01 | |
| CAPE | 000000003402 | 01 | |
| OMNICARE | 1008733 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295047710 | Northwest Detroit Dialysis Center LLC | Clinic/Center | 21000 Northwestern Hwy, Southfield, MI 48075-5306 | 2010-07-13 |
| Street Address |
25664 LAHSER RD |
| City | SOUTHFIELD |
| State | MI |
| Zip Code | 48033-5810 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114077823 | Kathryn Hayter | Nurse Practitioner | 25664 Lahser Rd, Southfield, MI 48033-5810 | 2007-01-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013531243 | Kenicka Harper | Case Manager/Care Coordinator | 2270 W Nine Mile Rd, Detroit, MI 48033 | 2020-06-03 |
| 1154955292 | Judy C Staples | Registered Nurse | 23800 West 10 Mile Road, Ste. 110, Southfield, MI 48033 | 2020-02-27 |
| 1578193827 | Axel Lee Gruenberg | Peer Specialist | 221790 West 9 Mile, Southfield, MI 48033 | 2020-01-24 |
| 1851958706 | William Beaumont Hospital | Clinic/Center | 26901 Beaumont Blvd., D - 5, Community Health, Southfield, MI 48033 | 2019-05-28 |
| 1396302857 | William Beaumont Hospital | Clinic/Center | Beaumont Service Center, 26901 Beaumont Blvd, Community Health, D - 5, Southfield, MI 48033 | 2019-05-21 |
| 1700442597 | Botsford General Hospital | Clinic/Center | 26901 Beaumont Blvd, Beaumont Service Center, Community Health, D - 5, Southfield, MI 48033 | 2019-05-16 |
| 1558862433 | Oakwood Accountable Care Organization, LLC | Preferred Provider Organization | 26901 Beaumont Blvd., Southfield, MI 48033 | 2018-02-26 |
| 1891228904 | Brandi Becker-wright | Social Worker | 25200 Telegraph Rd Ste 100, Southfield, MI 48033 | 2017-04-05 |
| 1003362252 | Mark Kline | Registered Nurse | 22170 W Nine Mile Rd, Southfield, MI 48033 | 2016-08-28 |
| 1033534797 | Jessica Savageau | Social Worker | 22170 W 9 Mile, Southfield, MI 48033 | 2014-03-04 |
| Find all providers in zip 48033 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801497961 | Saint Marina Home Dialysis LLC | Clinic/Center | 26711 Northwestern Hwy Ste 125, Southfield, MI 48033-2170 | 2020-11-05 |
| 1851886592 | Fms Rochester Hills, LLC | Clinic/Center | 26400 W 12 Mile Rd Ste 112, Southfield, MI 48034-1785 | 2018-06-26 |
| 1568849826 | Renal Treatment Centers Illinois Inc | Clinic/Center | 21900 Melrose Ave Ste 4, Southfield, MI 48075-7967 | 2015-05-06 |
| 1841614591 | Cure Dialysis LLC | Clinic/Center | 24001 Southfield Rd Ste 203b, Southfield, MI 48075-2847 | 2014-02-14 |
| 1295047710 | Northwest Detroit Dialysis Center LLC | Clinic/Center | 21000 Northwestern Hwy, Southfield, MI 48075-5306 | 2010-07-13 |
| 1083861959 | Tree City Dialysis LLC | Clinic/Center | 24467 W 10 Mile Rd, Southfield, MI 48033-2931 | 2008-08-22 |
| 1508828708 | Kidney Centers of Michigan LLC | Clinic/Center | 21900 Melrose Ave, Ste 4, Southfield, MI 48075-7967 | 2006-04-04 |
| 1679535926 | Kidney Centers of Michigan LLC | Clinic/Center | 23857 Greenfield Rd, Southfield, MI 48075-3122 | 2006-04-03 |
| 1508827015 | Dva Healthcare Renal Care Inc | Clinic/Center | 18544 W 8 Mile Rd, Southfield, MI 48075-4194 | 2006-04-01 |
| 1194211433 | Fms Beaumont Health, LLC | Clinic/Center | 26400 W 12 Mile Rd Ste 112, Southfield, MI 48034-1785 | 2018-07-10 |
| Find all providers in SOUTHFIELD | ||||
| City | SOUTHFIELD |
| Zip Code | 48033 |
Please comment or provide details below to improve the information on NORTHWEST DETROIT DIALYSIS CENTER LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.