Provider Demographics
NPI:1689987539
Name:LAKES DIALYSIS CENTER,INC
Entity Type:Organization
Organization Name:LAKES DIALYSIS CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBLESZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-817-8508
Mailing Address - Street 1:14645 NW 77TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2569
Mailing Address - Country:US
Mailing Address - Phone:305-817-8508
Mailing Address - Fax:305-817-8565
Practice Address - Street 1:14645 NW 77TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2569
Practice Address - Country:US
Practice Address - Phone:305-817-8508
Practice Address - Fax:305-817-8565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment