Provider Demographics
NPI:1457891178
Name:CAPE CORAL KIDNEY CENTER LLC
Entity Type:Organization
Organization Name:CAPE CORAL KIDNEY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF NURSING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-371-7878
Mailing Address - Street 1:2735 SANTA BARBARA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4481
Mailing Address - Country:US
Mailing Address - Phone:239-772-2988
Mailing Address - Fax:239-772-2989
Practice Address - Street 1:2735 SANTA BARBARA BLVD
Practice Address - Street 2:SUITES 100 & 200
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4481
Practice Address - Country:US
Practice Address - Phone:239-772-2988
Practice Address - Fax:239-772-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment