Organization
NRA-HOLLYWOOD, SOUTH CAROLINA, LLC
Active
Parent organization
FRESENIUS MEDICAL CARE HOLDINGS, INC.
Other names
HOLLYWOOD - RAVENEL DIALYSIS CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FRESENIUS MEDICAL CARE HOLDINGS, INC.
Authorized official
BARRY L. BLANTON (VICE PRESIDENT)
(781) 699-9000
Entity
Organization
Contact information
Practice address
5953 JACOBS POINT BLVD, RAVENEL, SC 29470-5643
(843) 571-4025
(843) 571-4015
Mailing address
5953 JACOBS POINT BLVD, RAVENEL, SC 29470-5643
(843) 571-4025
(843) 571-4015
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ERD-157
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42D1052012
CLIA CERTIFICATE OF WAIVE
SC
05
—
ERD-157
—
SC
Enumeration date
06/13/2006
Last updated
10/17/2023
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