BRADDOCK DIALYSIS LLC (NPI# 1326544925) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326544925 |
| Entity Type | Organization |
| Organization Name | BRADDOCK DIALYSIS LLC |
| Other Organization Name | WESTMONT DIALYSIS |
| Practice Address |
11239 S Western Ave Los Angeles CA 90047-4848 |
| Mailing Address |
5200 Virginia Way L&c Dept Brentwood TN 37027-7569 |
| Practice Telephone | 3232423970 |
| Practice Fax Number | 3234180549 |
| Mailing Telephone | 6153416282 |
| Mailing Fax Number | 8003365910 |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2019-11-06 |
| Authorized Official Name | JAMES K HILGER (CHIEF ACCOUNTING OFFICER) |
| Authorized Official Telephone | 2537334500 |
| 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 |
| Other Name | Type Code |
|---|---|
| Westmont Dialysis | Doing Business As Name - Organization |
| Street Address |
11239 S WESTERN AVE |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90047-4848 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063071652 | Cherae Nikia Stovall | Counselor | 1704 Manchester Boulevard, Suite 202, Los Angeles, CA 90047 | 2019-06-07 |
| 1598264053 | Dignity Health | Community/Behavioral Health | 1852 W Imperial Hwy, Los Angeles, CA 90047 | 2018-02-09 |
| 1750805222 | Brian George Martinez | Counselor | 1448 W 83rd St, Los Angeles, CA 90047 | 2017-07-27 |
| 1295266609 | Maria Amezcua | Rehabilitation Practitioner | 108 W Victoria Street, Gardena, CA 90047 | 2017-03-27 |
| 1265861140 | Ameika Porter | Counselor | 1529 West 82nd Street, Los Angeles, CA 90047 | 2013-11-01 |
| 1053747519 | Maria D Macias | Counselor | 11601 S. Western Avenue, Los Angeles, CA 90047 | 2013-09-16 |
| 1366704132 | Evelyn Carolina Hernandez | Family Medicine | 1555 West 110th Street, Los Angeles, CA 90047 | 2012-06-08 |
| 1003057142 | Sandra Patricia Trim | Licensed Vocational Nurse | 2048 W 69 St, Los Angeles, CA 90047 | 2009-03-19 |
| 1194962001 | Estuardo Ardon | Counselor | 11603 S. Western Ave., Los Angeles, CA 90047 | 2009-01-14 |
| 1174788400 | Frenda Brigette Williams | Dentist | 2015 W 81st St, Los Angeles, CA 90047 | 2008-07-25 |
| Find all providers in zip 90047 | ||||
| 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 |
|---|---|---|---|---|
| 1891305462 | Auberry's Home Hemo Dialysis | Clinic/Center | 8200 S Normandie Ave, Los Angeles, CA 90044-2336 | 2020-08-07 |
| 1720630304 | Kpc Global Dialysis Center of Los Angeles LLC | Clinic/Center | 201 S Alvarado St Ste 220, Los Angeles, CA 90057-2388 | 2019-07-12 |
| 1902377591 | Total Renal Care Inc | Clinic/Center | 11859 Wilshire Blvd Ste 100, Los Angeles, CA 90025-6653 | 2018-12-08 |
| 1205388246 | Fresenius Medical Care Ventures, LLC | Clinic/Center | 3705 S Labrea Avenue, Los Angeles, CA 90016-5309 | 2016-10-25 |
| 1629424726 | Downtown Dialysis LLC | Clinic/Center | 2511 W 3rd St, Los Angeles, CA 90057-1923 | 2016-05-06 |
| 1669839973 | Bio-medical Applications of California, Inc. | Clinic/Center | 3575 E Whittier Blvd, Los Angeles, CA 90023-1709 | 2016-01-19 |
| 1588031322 | Barnnyjepp, LLC | Clinic/Center | 1145 W 6th St, Los Angeles, CA 90017-1828 | 2015-08-27 |
| 1811235161 | Total Renal Care Inc | Clinic/Center | 1936 E 1st St, Los Angeles, CA 90033-3413 | 2013-01-22 |
| 1104111491 | Kidney Dialysis Center of Baldwin Hills LLC | Clinic/Center | 3705 S La Brea Ave, Los Angeles, CA 90016-5309 | 2011-06-14 |
| 1386962041 | Gala Dialysis, LLC | Clinic/Center | 1666 W 3rd St, Los Angeles, CA 90017-1138 | 2010-05-05 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90047 |
Please comment or provide details below to improve the information on BRADDOCK DIALYSIS 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.