Healthcare Provider Details

I. General information

NPI: 1174232011
Provider Name (Legal Business Name): WELLCARE DIALYSIS CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4589 PURDUE DR
BOYNTON BEACH FL
33436-7715
US

IV. Provider business mailing address

4589 PURDUE DR
BOYNTON BEACH FL
33436-7715
US

V. Phone/Fax

Practice location:
  • Phone: 561-315-1227
  • Fax:
Mailing address:
  • Phone: 561-315-1227
  • 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. EMMANUELLA BAZILME NERELUS
Title or Position: OWNER
Credential: RN
Phone: 561-315-1227