Healthcare Provider Details

I. General information

NPI: 1699322933
Provider Name (Legal Business Name): COWRY HOME DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 CALIBRE CROSSINGS NW SUITE # 1122
ACWORTH GA
30101
US

IV. Provider business mailing address

50 E SAMPLE RD STE 301
POMPANO BEACH FL
33064-3552
US

V. Phone/Fax

Practice location:
  • Phone: 954-781-7741
  • Fax:
Mailing address:
  • Phone: 954-781-7741
  • Fax: 888-349-8679

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
# 2
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MARCIA ANJOS SANTOS
Title or Position: COO
Credential:
Phone: 954-781-7741