MEDICARE: DIALYSIS CARE CENTER BROOKSVILLE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093381915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIALYSIS CARE CENTER BROOKSVILLE LLC

Provider Business Mailing Address
First Line	:	PO BOX 428
Second Line	:
City	:	LOCKPORT
State	:	IL
Zip	:	60441-6428
Country	:	US
Telephone Number	:	815-714-7170
Fax Number	:	630-672-4980

Provider Business Practice Location Address
First Line	:	7179 BROAD ST
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34601-5536
Country	:	US
Telephone Number	:	352-848-3689
Fax Number	:	352-777-4958

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MORUFU OLATUNJI ALAUSA
Credential	:	M.D.
Telephone Number	:	815-741-6830

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	05/05/2026

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