Organization
LIFEALYSIS KIDNEY CARE, LLC
Active
Other names
ONE ON ONE KIDNEY CARE
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN COMPLE RN (FACILITY ADMINISTRATOR)
(713) 569-3961
Entity
Organization
Contact information
Practice address
4300 FAIRMONT PKWY STE 100, PASADENA, TX 77504
(832) 617-8816
(713) 513-5394
Mailing address
4300 FAIRMONT PKWY STE 100, PASADENA, TX 77504-3306
(832) 617-8816
(713) 513-5394
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
—
—
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110508
ESRD LICENSE
TX
01
—
1976747
NOVITAS
TX
Enumeration date
06/13/2018
Last updated
06/17/2020
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