Organization
FLORIDA DIALYSIS CENTER OF HAINES CITY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA ANNE BRADY (CHIEF NURSING OFFICER)
(208) 371-7878
Entity
Organization
Contact information
Practice address
2340 NORTH BOULEVARD WEST, DAVENPORT, FL 33837-8924
(863) 353-6886
(863) 547-9527
Mailing address
2340 NORTH BOULEVARD WEST, DAVENPORT, FL 33837-8924
(863) 353-6886
(863) 547-9527
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
—
015769300
—
FL
Enumeration date
02/02/2015
Last updated
01/10/2023
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