Organization
PROVIDENCE HOME DIALYSIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHONTA WILLIAMS (COO)
(346) 388-0656
Entity
Organization
Contact information
Practice address
7737 BEECHNUT ST STE 102, HOUSTON, TX 77074-3109
(713) 861-7500
(713) 861-7502
Mailing address
7737 BEECHNUT ST STE 102, HOUSTON, TX 77074-3109
(713) 861-7500
(713) 861-7502
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
03/28/2023
Last updated
07/10/2023
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