Aberdeen Dialysis LLC
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Forest Hill, MD
NPI 1457652174 · NPPES record last updated May 31, 2022
Key facts
- NPI
- 1457652174
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- License
- E2668 (MD)
- Legal business name
- ABERDEEN DIALYSIS LLC
- Practice address
- 2220 Commerce Rd
Suite 1
Forest Hill, MD 21050-2560 - Phone
- (410) 638-6020
- Fax
- (410) 638-7180
- NPI assigned
- Nov 11, 2010
- Organization subpart
- No
Authorized official
- Name
- John D Winstel
- Title
- Chief Accounting Officer
- Phone
- (253) 733-4501
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Member of 2
Affiliated clinicians 2
-
Mohamad Hanouneh, M.D
-
Jonathan Lim, MD
Medicare Care Compare: Dialysis facility
- Listed as
- DaVita Forest Landing Dialysis
- Overall star rating
- ★★★☆☆ 3.0 of 5
- Ownership
- Profit
- Certified
- Nov 9, 2011
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 24
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 21D2024209 | Forest Landing Dialysis | Certificate of waiver | May 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110505000124 | MD | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 0648372961 | Practice locations: Forest Hill, MD |
National Provider Directory
- Tax ID family
- Aberdeen Dialysis LLC
Locations
2220 Commerce Rd
Ste 1
Forest Hill, MD 21050
Phone (410) 638-6020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | E2668 | MD | Yes |
Addresses
Primary practice location
2220 Commerce Rd
Suite 1
Forest Hill, MD 21050-2560
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 320-4214
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 421193600 | Medicaid | MD |
Other names
- Forest Landing Dialysis
Other providers in Forest Hill, MD
All providers in Forest Hill, MD · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.