Organization
SOUTH TEXAS HOME HEMODIALYSIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABHAY MANGLIK (DIRECTOR OF OPERATIONS)
(214) 331-1112
Entity
Organization
Contact information
Practice address
3571 W WHEATLAND RD, DALLAS, TX 75237-3461
(214) 331-1112
Mailing address
3571 W WHEATLAND RD, DALLAS, TX 75237-3461
(214) 331-1112
(214) 331-1115
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
—
1821477415
LIBERTY AT HOME DIALYSIS, LLC
—
Enumeration date
12/07/2017
Last updated
12/07/2017
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