Grand Dialysis Services LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

L15000170783 Issued in FL

Legal business name

GRAND DIALYSIS SERVICES LLC

Practice address

500 N. Hiatus Road
Suite 105
Pembroke Pines, FL 33026

Phone

(954) 962-9640

NPI assigned

Nov 20, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Keith Carrasco

Title

Administrator

Phone

(954) 962-9640

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

End-stage renal disease facility certification: CCN 682643

Legal name

GRAND DIALYSIS SERVICES LLC

Certification status

Active

Provider type (POS)

End-stage renal disease facility

Participating since

May 18, 2018

Last certification

Jun 27, 2023

Ownership / control type

For Profit

Multi-facility organization

FRESENIUS

Facility address

500 N Hiatus Road, Ste 105
Pembroke Pines, FL 33026

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Manjit Singh Gulati, MD

  • Nephrology Physician
  • Davie, FL
  • NPI 1164433256
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597104000000",
    "number": "1659745149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7765 JOHNSON ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330246856",
            "telephone_number": "954-962-9640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N. HIATUS ROAD",
            "address_2": "SUITE 105",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "33026",
            "telephone_number": "954-962-9640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND DIALYSIS SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-20",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A",
        "authorized_official_last_name": "CARRASCO",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "954-962-9640"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "FL",
            "license": "L15000170783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tomasz A Grabczak, DDS
• Grace Oropesa LLC
• Noe Junior Grados, PHARM D
• Danilo Grahovac, MD
• Lena Granado Lopez, RBT
• Nigel Dave Grandison, DMD
• Jamie Roberts Granie, FNP-BC
• Tashna Grant-Williams
• Cassandra Grant
• Gwendalyn Grant, ARNP

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.