| NPI | 1740400431 |
|---|---|
| Doing Business As | GRAND CONCOURSE DIALYSIS FACILITY |
| Entity Type | Organization |
| Authorized Contact | DOMINIC LICCIARDI Administrator 718-987-5942 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2023-10-12 |