Provider Demographics
NPI:1740431089
Name:LIFELINE DIALYSIS CENTER, LLC
Entity Type:Organization
Organization Name:LIFELINE DIALYSIS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN./CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:VERBAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-676-5488
Mailing Address - Street 1:3601 W COMMERCIAL BLVD
Mailing Address - Street 2:#35
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3300
Mailing Address - Country:US
Mailing Address - Phone:954-676-5488
Mailing Address - Fax:954-676-5560
Practice Address - Street 1:3601 W COMMERCIAL BLVD
Practice Address - Street 2:#35
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3300
Practice Address - Country:US
Practice Address - Phone:954-676-5488
Practice Address - Fax:954-676-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1257170001OtherMEDICARE PROVIDER NUMBER