Healthcare Provider Details

I. General information

NPI: 1427553510
Provider Name (Legal Business Name): APPLE RENAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5784 JILLIAN WAY
GRAND PRAIRIE TX
75052
US

IV. Provider business mailing address

5784 JILLIAN WAY
GRAND PRAIRIE TX
75052-0418
US

V. Phone/Fax

Practice location:
  • Phone: 817-449-7705
  • Fax:
Mailing address:
  • Phone: 817-449-7705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number846625
License Number StateTX

VIII. Authorized Official

Name: JOSEPHAT OMWENO KIROCHI
Title or Position: OWNER
Credential: RN
Phone: 817-449-7705