Organization
DECATUR HOME DIALYSIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SANDRA FRITZSCH (MEMBER)
(513) 673-5245
Entity
Organization
Contact information
Practice address
2301 S FM 51, DECATUR, TX 76234-3865
(940) 627-0009
Mailing address
4930 BROOKSVIEW CIR, NEW ALBANY, OH 43054-9275
(940) 627-0009
(888) 788-1449
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
05
—
3971400-01
—
TX
01
—
74-2523
MEDICARE
TX
Enumeration date
08/26/2017
Last updated
03/14/2022
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