Organization Name: | GUAM DIALYSIS CENTER, INC. |
NPI Number: | 1053383059 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JERRY GREEN (SECRETARY) |
Mailing Address: | 633 Governor Carlos B. Camacho Rd 106 Tamuning |
State: | GU US |
Postal Code: | 96913 |
Phone Number: | 6716463517 |
Fax Number: | 6716463531 |
NPI Enumeration Date: | 02/03/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |