=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699322933
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COWRY HOME DIALYSIS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2019
-----------------------------------------------------
Last Update Date | 02/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4450 CALIBRE CROSSINGS NW SUITE # 1122
-----------------------------------------------------
City | ACWORTH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-781-7741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 E SAMPLE RD STE 301
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33064-3552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-781-7741
-----------------------------------------------------
Fax | 888-349-8679
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | MARCIA ANJOS SANTOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-781-7741
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BD1200X
-----------------------------------------------------
Taxonomy Name | Dialysis Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------