MEDICARE: ELIK DIALYSIS HOME THERAPY - MEMORIAL II LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1417474156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIK DIALYSIS HOME THERAPY - MEMORIAL II LLC

Provider Business Mailing Address
First Line	:	1445 NORTH LOOP W STE 740
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1676
Country	:	US
Telephone Number	:	713-861-7500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1445 NORTH LOOP W STE 740
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1676
Country	:	US
Telephone Number	:	713-861-7500
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	DR. JOHN IKE
Credential	:	MD
Telephone Number	:	713-861-7500

Provider Enumeration Date	:	08/24/2017
Last Update Date	:	07/21/2022

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