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
—
—
Other
Enumeration date
12/20/2012
Last updated
09/11/2014
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