Organization
PURE LIFE RENAL OF OVERLAND PARK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF FERNANDEZ (CFO)
(954) 962-5733
Entity
Organization
Contact information
Practice address
11661 COLLEGE BLVD STE 106, OVERLAND PARK, KS 66210-4107
(954) 962-5733
Mailing address
4000 HOLLYWOOD BLVD STE 300N, HOLLYWOOD, FL 33021-1242
(954) 962-5733
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
02/27/2020
Last updated
02/27/2020
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