Healthcare Provider Details

I. General information

NPI: 1902564107
Provider Name (Legal Business Name): APEX DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2021
Last Update Date: 12/04/2021
Certification Date: 12/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 WATSON LN
MIDDLETOWN DE
19709-9389
US

IV. Provider business mailing address

34 WATSON LN
MIDDLETOWN DE
19709-9389
US

V. Phone/Fax

Practice location:
  • Phone: 302-668-9851
  • Fax:
Mailing address:
  • Phone: 302-668-9851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MRS. PHYLLIS AGOVI BANAHENE
Title or Position: OWNER
Credential: RN
Phone: 302-668-9851