Organization
LIFELINERENALCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SIJI THOMAS (PARTNER)
(630) 687-5955
Entity
Organization
Contact information
Practice address
2517 SCOTTI ST, LEWISVILLE, TX 75056-5882
(630) 687-5966
Mailing address
2517 SCOTTI ST, LEWISVILLE, TX 75056-5882
(630) 687-5966
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37619064
DL
TX
Enumeration date
08/24/2017
Last updated
07/21/2022
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