Provider Demographics
NPI:1255833844
Name:KIDNEY CARE OF KENDALL DIALYSIS CENTER INC.
Entity Type:Organization
Organization Name:KIDNEY CARE OF KENDALL DIALYSIS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:FREDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MISENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-318-3169
Mailing Address - Street 1:13501 S.W. 136TH STREET
Mailing Address - Street 2:210
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186
Mailing Address - Country:US
Mailing Address - Phone:305-318-3169
Mailing Address - Fax:305-623-7880
Practice Address - Street 1:13501 S.W. 136TH STREET
Practice Address - Street 2:210
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186
Practice Address - Country:US
Practice Address - Phone:305-318-3169
Practice Address - Fax:305-623-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment