Organization
LIFELINE DIALYSIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BIJU KURIAKOSE REGISTERED NURSE (CHIEF OPERATING OFFICER)
(903) 455-9911
Entity
Organization
Contact information
Practice address
4309 RIDGECREST RD STE 100, GREENVILLE, TX 75402-6003
(903) 455-9911
Mailing address
4309 RIDGECREST RD STE 100, GREENVILLE, TX 75402-6003
(903) 455-9911
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
09/15/2022
Last updated
09/15/2022
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