Provider Demographics
NPI:1114284494
Name:KIDNEY KARE OF JACKSONVILLE FL, INC.
Entity Type:Organization
Organization Name:KIDNEY KARE OF JACKSONVILLE FL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-764-7695
Mailing Address - Street 1:326 E DANIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-3028
Mailing Address - Country:US
Mailing Address - Phone:954-764-7695
Mailing Address - Fax:954-764-7697
Practice Address - Street 1:4168 SOUTHPOINT PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-0966
Practice Address - Country:US
Practice Address - Phone:954-764-7695
Practice Address - Fax:954-764-7697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment