Organization Active NPI

Elizabethtown Center LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Elizabethtown, NY
National Provider Identifier
1053742569
Registry record updated May 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
ELIZABETHTOWN CENTER LLC
Practice address
75 Park St
Elizabethtown, NY 12932-2300
Phone
(518) 873-2162
Fax
(518) 873-2144
NPI assigned
Dec 9, 2013
Last updated
May 20, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sara Anne Brady
Title
Chief Nursing Officer
Phone
(208) 371-7878

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary

Addresses

Primary practice location

75 Park St
Elizabethtown, NY 12932-2300

Mailing address

PO Box 277
Elizabethtown, NY 12932-0277
Phone (518) 873-2162

Other identifiers 1

IdentifierTypeStateIssuer
03937280MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140409001926 NY Part A Provider - End-Stage Renal Disease Facility (ESRD) 2365674165 Practice locations: Elizabethtown, NY

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Elizabethtown Center, LLCCCN 332710
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Apr 1, 2014
Medicare certification status
ActiveFrom the Provider of Services file
Chain
American Renal Associates
Dialysis stations
8

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D2072084Elizabethtown Center LLC75 Park Street, Elizabethtown, NY 12932Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779235200000",
    "number": "1053742569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277",
            "city": "ELIZABETHTOWN",
            "state": "NY",
            "postal_code": "129320277",
            "telephone_number": "518-873-2162",
            "fax_number": "518-873-2144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 PARK ST",
            "city": "ELIZABETHTOWN",
            "state": "NY",
            "postal_code": "129322300",
            "telephone_number": "518-873-2162",
            "fax_number": "518-873-2144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZABETHTOWN CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-09",
        "last_updated": "2026-05-20",
        "certification_date": "2026-05-20",
        "status": "A",
        "authorized_official_last_name": "BRADY",
        "authorized_official_first_name": "SARA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "CHIEF NURSING OFFICER",
        "authorized_official_telephone_number": "208-371-7878"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03937280",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethtown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.