Provider Demographics
NPI:1588920870
Name:COASTAL DIALYSIS CENTER, LLC
Entity type:Organization
Organization Name:COASTAL DIALYSIS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RABIEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-253-8121
Mailing Address - Street 1:641 UNIVERSITY BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2794
Mailing Address - Country:US
Mailing Address - Phone:561-253-8121
Mailing Address - Fax:
Practice Address - Street 1:641 UNIVERSITY BLVD STE 209
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2794
Practice Address - Country:US
Practice Address - Phone:561-253-8121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment