Provider Demographics
NPI:1750660247
Name:CROWN DIALYSIS CENTER OF PALM BEACH LLC
Entity Type:Organization
Organization Name:CROWN DIALYSIS CENTER OF PALM BEACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BHARAT
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-993-5757
Mailing Address - Street 1:4701 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5135
Mailing Address - Country:US
Mailing Address - Phone:954-993-5757
Mailing Address - Fax:954-577-5776
Practice Address - Street 1:4701 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5135
Practice Address - Country:US
Practice Address - Phone:954-993-5757
Practice Address - Fax:954-577-5776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment