Healthcare Provider Details

I. General information

NPI: 1457638595
Provider Name (Legal Business Name): HOME DIALYSIS OF NEW MEXICO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LOMAS BLVD NE THREE WOODWARD CENTER
ALBUQUERQUE NM
87102-2568
US

IV. Provider business mailing address

700 LOMAS BLVD NE THREE WOODWARD CENTER
ALBUQUERQUE NM
87102-2568
US

V. Phone/Fax

Practice location:
  • Phone: 505-842-5210
  • Fax:
Mailing address:
  • Phone: 505-842-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BIJU CHERIAN
Title or Position: PARTNER
Credential: M.D.
Phone: 505-842-5210