1184639957 NPI number — HOME KIDNEY CARE, LLC

Table of content: (NPI 1184639957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184639957 NPI number — HOME KIDNEY CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME KIDNEY CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DALLAS HOME TRAINING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184639957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 VIRGINIA WAY
Provider Second Line Business Mailing Address:
L&C DEPARTMENT
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-7569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-341-6764
Provider Business Mailing Address Fax Number:
833-781-6999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6200 LBJ FWY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75240-6355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-466-7233
Provider Business Practice Location Address Fax Number:
214-393-4738
Provider Enumeration Date:
07/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WINSTEL
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF ACCOUNTING OFFICER
Authorized Official Telephone Number:
253-733-4501

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1587628-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000HH6499 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".