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General NPI Number Information
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NPI Number | 1518319706
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Entity Type | Organization
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Legal Business Name | LONE STAR HOME DIALYSIS, INC.
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Dates
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Enumeration Date | 07/12/2016
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 16903 RED OAK DR STE 100B
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City | HOUSTON
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State | TX
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Zip | 77090-3917
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Country | US
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Telephone | 362-719-4429
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Fax | 800-395-8956
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Provider Business Mailing Address
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Address Line | 16903 RED OAK DR STE 100B
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City | HOUSTON
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State | TX
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Zip | 77090-3917
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Country | US
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Telephone | 936-271-9442
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Fax | 800-395-8956
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Authorized Official
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Title or Position | CEO, CFO
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Name | BALBEER K GODWIN
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Credential | R.N
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Telephone | 281-799-7089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | TX
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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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