Provider Demographics
NPI:1043491194
Name:GARFIELD DIALYSIS VENTURE LLC
Entity Type:Organization
Organization Name:GARFIELD DIALYSIS VENTURE LLC
Other - Org Name:HUMBOLDT RIDGE DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LUCKENBILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-777-5200
Mailing Address - Street 1:2514 S 102ND ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2142
Mailing Address - Country:US
Mailing Address - Phone:414-777-5200
Mailing Address - Fax:414-777-5210
Practice Address - Street 1:2211 N HUMBOLDT BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3507
Practice Address - Country:US
Practice Address - Phone:414-336-7200
Practice Address - Fax:414-777-5210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center