Healthcare Provider Details

I. General information

NPI: 1841237021
Provider Name (Legal Business Name): EUMANA HOME DIALYSIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 LA CONCHA LN
HOUSTON TX
77054-1809
US

IV. Provider business mailing address

1313 LA CONCHA LN
HOUSTON TX
77054-1809
US

V. Phone/Fax

Practice location:
  • Phone: 713-668-2744
  • Fax: 713-795-5959
Mailing address:
  • Phone: 713-668-2744
  • Fax: 713-795-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0300X
TaxonomyNephrology Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DAVID CLARK
Title or Position: AR SUPERVISOR
Credential:
Phone: 936-597-6467