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Organization
END STAGE RENAL DISEASE HOME CARE PROVIDER AGENCY
Active
Organization
END STAGE RENAL DISEASE HOME CARE PROVIDER AGENCY
Active
Other names
none
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM HENRY DAVIS JR. (OWNER/SUPPLY)
(414) 759-8587
Entity
Organization
Contact information
Practice address
22356 W LASSO LN, BUCKEYE, AZ 85326-5979
(623) 210-2710
Mailing address
PO BOX 6911, GOODYEAR, AZ 85338-0632
(414) 759-8587
Taxonomy
Speciality
Code
Description
License number
State
332BD1200X
Dialysis Equipment & Supplies (DME)
Primary
—
NULL
Other
Enumeration date
12/20/2012
Last updated
09/11/2014
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