Organization
FORT LAUDERDALE RENAL DIALYSIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARI K COUSINS (SR. VP OF CLINICAL & REGULATORY)
(978) 922-3080
Entity
Organization
Contact information
Practice address
6264 N FEDERAL HWY, FORT LAUDERDALE, FL 33308-1904
(954) 776-3791
(954) 771-7527
Mailing address
6264 N FEDERAL HWY, FORT LAUDERDALE, FL 33308-1904
(954) 776-3791
(954) 771-7527
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
—
005936600
—
FL
Enumeration date
03/08/2012
Last updated
03/16/2020
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