Organization
PURE LIFE RENAL OF LANSDOWNE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFF FERNANDEZ (CFO)
(954) 962-5733
Entity
Organization
Contact information
Practice address
19490 SANDRIDGE WAY, SUITE 140, LEESBURG, VA 20176-3465
(954) 962-5733
Mailing address
4000 HOLLYWOOD BLVD, SUITE 300-N, HOLLYWOOD, FL 33021-6751
(216) 264-0284
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
02/28/2017
Last updated
08/12/2022
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