Provider Demographics
NPI:1609117324
Name:ULTIMATE CARE DIALYSIS CENTER LLC
Entity Type:Organization
Organization Name:ULTIMATE CARE DIALYSIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:VALIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-226-2699
Mailing Address - Street 1:2720 SW 97TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2677
Mailing Address - Country:US
Mailing Address - Phone:305-226-2699
Mailing Address - Fax:305-226-4199
Practice Address - Street 1:2720 SW 97TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2677
Practice Address - Country:US
Practice Address - Phone:305-226-2699
Practice Address - Fax:305-226-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment