Healthcare Provider Details

I. General information

NPI: 1306616404
Provider Name (Legal Business Name): KIDNEY CARE OF LABELLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N BRIDGE ST STE 200
LABELLE FL
33935-5083
US

IV. Provider business mailing address

4960 SW 72ND AVE STE 208
MIAMI FL
33155-5549
US

V. Phone/Fax

Practice location:
  • Phone: 863-339-7040
  • Fax:
Mailing address:
  • Phone: 305-448-6261
  • Fax: 305-448-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: FEDERICO A DUMENIGO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 305-448-6261