MEDICARE: ST. BERNADETTE OF LOURDES DIALYSIS AND EDUCATION CENTER,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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center		TX

General Provider Information

NPI Number	:	1659677987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. BERNADETTE OF LOURDES DIALYSIS AND EDUCATION CENTER,LLC.

Provider Business Mailing Address
First Line	:	12224 ALMEDA RD STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-3735
Country	:	US
Telephone Number	:	713-433-7252
Fax Number	:	713-433-2222

Provider Business Practice Location Address
First Line	:	12224 ALMEDA RD
Second Line	:	STE B
City	:	HOUSTON
State	:	TX
Zip	:	77045-3735
Country	:	US
Telephone Number	:	713-433-7252
Fax Number	:	713-433-2222

Authorized Official
Title or Position	:	FACILITY ADMINISTRATOR
Name	:	MS. JULIE ANN ALMAZAR YAP
Credential	:	RN, CHN
Telephone Number	:	713-433-7252

Provider Enumeration Date	:	02/03/2011
Last Update Date	:	03/22/2011

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