| Organization Name: | LIBERTY DIALYSIS - JORDAN LANDING LLC |
| NPI Number: | 1073846655 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RYAN B PARDO (VICE PRESIDENT) |
| Mailing Address: | 3823 West 9000 South Suite D West Jordan |
| State: | UT US |
| Postal Code: | 840888899 |
| Phone Number: | 8012804600 |
| Fax Number: | |
| NPI Enumeration Date: | 09/14/2009 |
| NPI Last Update Date: | 11/16/2010 |
| 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: | |