Organization
JOHNSON DIALYSIS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH CARRASCO (ADMINISTRATOR)
(954) 962-9640
Entity
Organization
Contact information
Practice address
7769 JOHNSON ST, PEMBROKE PINES, FL 33024-6856
(954) 962-9640
(954) 962-9641
Mailing address
7769 JOHNSON ST, PEMBROKE PINES, FL 33024-6856
(954) 962-9640
(954) 962-9641
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000791100
—
FL
Enumeration date
08/21/2007
Last updated
08/11/2020
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