# END STAGE RENAL DISEASE HOME CARE PROVIDER AGENCY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** none
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083950984
- **Authorized official:** MR. WILLIAM HENRY DAVIS JR. (OWNER/SUPPLY)
- **Authorized official phone:** (414) 759-8587

## Contact information

- **Practice address:** 22356 W LASSO LN, BUCKEYE, AZ 85326-5979
- **Practice address phone:** (623) 210-2710
- **Mailing address:** PO BOX 6911, GOODYEAR, AZ 85338-0632
- **Mailing address phone:** (414) 759-8587

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332BD1200X | Dialysis Equipment & Supplies (DME) | — | NULL | Yes |

## Other

- **Enumeration date:** 12/20/2012
- **Last updated:** 09/11/2014