1821509696 NPI number — GLOBAL HOME DIALYSIS

Table of content: (NPI 1821509696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821509696 NPI number — GLOBAL HOME DIALYSIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLOBAL HOME DIALYSIS
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:
Provider Other Organization Name Type Code:
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:
1821509696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11611 WEST AIRPORT BLVD.,
Provider Second Line Business Mailing Address:
STE H #106
Provider Business Mailing Address City Name:
MEADOWS PLACE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-980-0787
Provider Business Mailing Address Fax Number:
346-299-9161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12823 CAPRICORN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAFFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-980-0787
Provider Business Practice Location Address Fax Number:
346-299-9161
Provider Enumeration Date:
10/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
COLETTE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
713-816-1487

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  011843 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BD1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0103077 . This is a "DURABLE MEDICAL EQUIPMENT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 011843 . This is a "TEXAS DEPARTMENT OF AGING AND DISABILITY SERVICES" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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