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General NPI Number Information
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NPI Number | 1750808374
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Entity Type | Organization
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Legal Business Name | LIFELINERENALCARE
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Dates
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Enumeration Date | 08/24/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2517 SCOTTI ST
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City | LEWISVILLE
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State | TX
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Zip | 75056-5882
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Country | US
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Telephone | 630-687-5966
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Fax |
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Provider Business Mailing Address
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Address Line | 2517 SCOTTI ST
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City | LEWISVILLE
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State | TX
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Zip | 75056-5882
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Country | US
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Telephone | 630-687-5966
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. SIJI THOMAS
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Credential |
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Telephone | 630-687-5955
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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 |
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