Healthcare Provider Details

I. General information

NPI: 1861173981
Provider Name (Legal Business Name): HOMECARE DIALYSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 W SIERRA VISTA DR
GLENDALE AZ
85303-3556
US

IV. Provider business mailing address

7220 W SIERRA VISTA DR
GLENDALE AZ
85303-3556
US

V. Phone/Fax

Practice location:
  • Phone: 786-800-8720
  • Fax:
Mailing address:
  • Phone: 786-800-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JULIAN ALBURQUERQUE
Title or Position: CEO
Credential:
Phone: 786-800-8720