Provider Demographics
NPI:1023573490
Name:ARC DIALYSIS HIALEAH LLC
Entity Type:Organization
Organization Name:ARC DIALYSIS HIALEAH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:DUMENIGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-322-6412
Mailing Address - Street 1:2601 SW 37TH AVE STE 138
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2750
Mailing Address - Country:US
Mailing Address - Phone:305-448-6261
Mailing Address - Fax:305-448-6268
Practice Address - Street 1:3704 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4126
Practice Address - Country:US
Practice Address - Phone:305-448-6261
Practice Address - Fax:305-448-6268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-09
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment