Healthcare Provider Details

I. General information

NPI: 1164834099
Provider Name (Legal Business Name): FIVE STAR DIALYSIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 08/25/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3327 S SAM HOUSTON PKWY E STE 200B
HOUSTON TX
77047-6549
US

IV. Provider business mailing address

3327 S SAM HOUSTON PKWY E STE 200B
HOUSTON TX
77047-6549
US

V. Phone/Fax

Practice location:
  • Phone: 713-436-1811
  • Fax: 281-506-8751
Mailing address:
  • Phone: 713-436-1811
  • Fax: 281-506-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO E GERALDO
Title or Position: ADMINISTRATOR / CFO
Credential: RN
Phone: 713-436-1811