Provider Demographics
NPI:1972074086
Name:WEST ORANGE PALM COAST DIALYSIS CENTER LLC
Entity Type:Organization
Organization Name:WEST ORANGE PALM COAST DIALYSIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:AKIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AWOSIKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-927-5873
Mailing Address - Street 1:1210 E PLANT ST STE 120
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2995
Mailing Address - Country:US
Mailing Address - Phone:407-297-8408
Mailing Address - Fax:
Practice Address - Street 1:57 TOWN CT STE 118
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2425
Practice Address - Country:US
Practice Address - Phone:407-297-8408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment