MEDICARE: CENTER FOR HOME DIALYSIS AT LAKEWOOD RANCH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1457992414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR HOME DIALYSIS AT LAKEWOOD RANCH LLC

Provider Business Mailing Address
First Line	:	PO BOX 1685
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34682-1685
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1939 WORTH COURT
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34211
Country	:	US
Telephone Number	:	727-215-0940
Fax Number	:	727-287-6305

Authorized Official
Title or Position	:	CEO
Name	:	MURALIDHAR K ACHARYA
Credential	:	MD
Telephone Number	:	727-808-2227

Provider Enumeration Date	:	10/01/2019
Last Update Date	:	10/01/2019

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