Healthcare Provider Details

I. General information

NPI: 1386491306
Provider Name (Legal Business Name): REBERTH DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18207 N ELDRIDGE PKWY UNIT A5
TOMBALL TX
77377-8169
US

IV. Provider business mailing address

18207 N ELDRIDGE PKWY UNIT A5
TOMBALL TX
77377-8169
US

V. Phone/Fax

Practice location:
  • Phone: 713-261-0441
  • Fax: 210-830-9385
Mailing address:
  • Phone: 713-261-0441
  • Fax: 210-830-9385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: KENYON HADLEY
Title or Position: CEO
Credential:
Phone: 713-261-0441