Provider Demographics
NPI:1558792960
Name:HOLLYWOOD DIALYSIS, LLC
Entity Type:Organization
Organization Name:HOLLYWOOD DIALYSIS, LLC
Other - Org Name:FRESENIUS KIDNEY CARE HOLLYWOOD - BOULEVARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:4000 HOLLYWOOD BLVD STE 175S
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6775
Mailing Address - Country:US
Mailing Address - Phone:954-962-3100
Mailing Address - Fax:954-962-3200
Practice Address - Street 1:4000 HOLLYWOOD BLVD STE 175S
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6775
Practice Address - Country:US
Practice Address - Phone:954-962-3100
Practice Address - Fax:954-962-3200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-11
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012350600Medicaid