Provider Demographics
NPI:1003265174
Name:ALLIANCE RENAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:ALLIANCE RENAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DIZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-881-1104
Mailing Address - Street 1:21354 TREBUCHET DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1474
Mailing Address - Country:US
Mailing Address - Phone:817-881-1104
Mailing Address - Fax:972-499-0029
Practice Address - Street 1:21354 TREBUCHET DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1474
Practice Address - Country:US
Practice Address - Phone:817-881-1104
Practice Address - Fax:972-499-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health