Provider Demographics
NPI:1013457720
Name:PURE LIFE RENAL OF LANSDOWNE, LLC
Entity Type:Organization
Organization Name:PURE LIFE RENAL OF LANSDOWNE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-962-5733
Mailing Address - Street 1:4000 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 300-N
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6751
Mailing Address - Country:US
Mailing Address - Phone:216-264-0284
Mailing Address - Fax:
Practice Address - Street 1:19490 SANDRIDGE WAY
Practice Address - Street 2:SUITE 140
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3465
Practice Address - Country:US
Practice Address - Phone:954-962-5733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment