| Organization Name: | MICHIGAN HOME DIALYSIS CENTER, INC. |
| NPI Number: | 1023123874 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK FAWCETT (TREASURER) |
| Mailing Address: | 3960 Patient Care Way Suite 112 Lansing |
| State: | MI US |
| Postal Code: | 489114275 |
| Phone Number: | 5173930352 |
| Fax Number: | |
| NPI Enumeration Date: | 08/20/2006 |
| NPI Last Update Date: | 12/29/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |