Provider Demographics
NPI:1699755355
Name:HALLANDALE ARTIFICIAL KIDNEY CENTER, INC.
Entity type:Organization
Organization Name:HALLANDALE ARTIFICIAL KIDNEY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURRIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:954-474-7702
Mailing Address - Street 1:7061 CYPRESS RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2243
Mailing Address - Country:US
Mailing Address - Phone:954-474-7701
Mailing Address - Fax:954-474-7702
Practice Address - Street 1:2655 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4840
Practice Address - Country:US
Practice Address - Phone:954-925-9909
Practice Address - Fax:954-927-5852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV1SOtherBC/BS PROVIDER NO
FL10-2601Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.