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General NPI Number Information
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NPI Number | 1821273558
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Entity Type | Organization
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Legal Business Name | ELIK DIALYSIS HOME THERAPY MANAGEMENT LLC
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 311 RR 620 SOUTH SUITE 103
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City | AUSTIN
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State | TX
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Zip | 78734-4747
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Country | US
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Telephone | 512-266-8135
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Fax | 512-266-9266
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Provider Business Mailing Address
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Address Line | 311 RR 620 SOUTH SUITE 103
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City | AUSTIN
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State | TX
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Zip | 78734-4747
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Country | US
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Telephone | 512-266-8135
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Fax | 512-266-9266
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. BALBEER K GODWIN
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Credential | REGISTERED NURSE RN
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Telephone | 512-203-3826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WD1100X
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Taxonomy Name | Peritoneal Dialysis Registered Nurse
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License Number | 537328
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License Number State | TX
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