Organization
GRAND DIALYSIS SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH CARRASCO (ADMINISTRATOR)
(954) 962-9640
Entity
Organization
Contact information
Practice address
500 N. HIATUS ROAD, SUITE 105, PEMBROKE PINES, FL 33026
(954) 962-9640
Mailing address
7765 JOHNSON ST, PEMBROKE PINES, FL 33024-6856
(954) 962-9640
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
L15000170783
FL
Other
Enumeration date
11/20/2015
Last updated
08/11/2020
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