Organization
ULTIMATE RENAL CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JUAN GUMABON CANLAS (ADMINISTRATOR)
(301) 927-8808
Entity
Organization
Contact information
Practice address
2426 CHILLUM RD, HYATTSVILLE, MD 20782-3629
(301) 927-8808
(301) 927-8809
Mailing address
2426 CHILLUM RD, HYATTSVILLE, MD 20782-3629
(301) 927-8808
(301) 927-8809
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
E2614
MD
Other
Enumeration date
10/02/2006
Last updated
08/16/2007
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