MEDICARE: CARING HEART METRO WEST DIALYSIS 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	:	1720559198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARING HEART METRO WEST DIALYSIS LLC

Provider Business Mailing Address
First Line	:	7786 NEWLAN DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-1231
Country	:	US
Telephone Number	:	305-308-8676
Fax Number	:

Provider Business Practice Location Address
First Line	:	1743 PARK CENTER DR STE 300
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-7621
Country	:	US
Telephone Number	:	305-308-8676
Fax Number	:

Authorized Official
Title or Position	:	MEMBER MANAGER
Name	:	MS. TRACEY JEAN
Credential	:
Telephone Number	:	305-308-8676

Provider Enumeration Date	:	12/11/2018
Last Update Date	:	12/11/2018

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