Organization
LIFEALYSIS KIDNEY CARE, LLC
Active
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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