Provider Demographics
NPI:1861479040
Name:RENAL CAREPARTNERS OF DAVIE
Entity Type:Organization
Organization Name:RENAL CAREPARTNERS OF DAVIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, CFO
Authorized Official - Prefix:
Authorized Official - First Name:ORESTES
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-512-0014
Mailing Address - Street 1:14361 COMMERCE WAY
Mailing Address - Street 2:306
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1565
Mailing Address - Country:US
Mailing Address - Phone:305-512-0014
Mailing Address - Fax:
Practice Address - Street 1:4970 SW 52ND ST
Practice Address - Street 2:325
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-5531
Practice Address - Country:US
Practice Address - Phone:305-512-0014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2008-09-24
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
FL102828Medicare Oscar/Certification