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General NPI Number Information
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NPI Number | 1093381915
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Entity Type | Organization
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Legal Business Name | DIALYSIS CARE CENTER BROOKSVILLE LLC
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Dates
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Enumeration Date | 06/01/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 7179 BROAD ST
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City | BROOKSVILLE
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State | FL
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Zip | 34601-5536
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Country | US
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Telephone | 352-848-3689
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Fax | 352-777-4958
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Provider Business Mailing Address
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Address Line | PO BOX 3134
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City | JOLIET
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State | IL
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Zip | 60434-3134
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Country | US
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Telephone | 815-714-7170
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Fax | 630-672-4980
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MORUFU OLATUNJI ALAUSA
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Credential | M.D.
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Telephone | 815-741-6830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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