Healthcare Provider Details

I. General information

NPI: 1124477112
Provider Name (Legal Business Name): HOME DIALYSIS OF SANTA FE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2904 RODEO PARK DR E STE 300A-1
SANTA FE NM
87505-6305
US

IV. Provider business mailing address

PO BOX 22566
SANTA FE NM
87502-2566
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-8199
  • Fax: 505-467-8519
Mailing address:
  • Phone: 505-467-8199
  • Fax: 505-467-8519

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: BIJU CHERIAN
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 505-264-8120