Provider Demographics
NPI:1245875483
Name:ARC DIALYSIS MIAMI LAKES, LLC
Entity type:Organization
Organization Name:ARC DIALYSIS MIAMI LAKES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YOSMANY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-661-2178
Mailing Address - Street 1:5600 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6135
Mailing Address - Country:US
Mailing Address - Phone:786-661-2178
Mailing Address - Fax:
Practice Address - Street 1:5600 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDEN
Practice Address - State:FL
Practice Address - Zip Code:33014-6135
Practice Address - Country:US
Practice Address - Phone:786-661-2178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment