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General NPI Number Information
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NPI Number | 1184117103
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Entity Type | Organization
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Legal Business Name | LIFEALYSIS KIDNEY CARE, LLC
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 4300 FAIRMONT PKWY STE 100
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City | PASADENA
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State | TX
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Zip | 77504
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Country | US
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Telephone | 832-617-8816
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Fax | 713-513-5394
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Provider Business Mailing Address
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Address Line | 4300 FAIRMONT PKWY STE 100
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City | PASADENA
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State | TX
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Zip | 77504-3306
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Country | US
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Telephone | 832-617-8816
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Fax | 713-513-5394
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Authorized Official
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Title or Position | FACILITY ADMINISTRATOR
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Name | ALAN COMPLE
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Credential | RN
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Telephone | 713-569-3961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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