Provider Demographics
NPI:1043697220
Name:TERRA-BOSON HOME DIALYSIS, LLC
Entity Type:Organization
Organization Name:TERRA-BOSON HOME DIALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:UDAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOSLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-520-6875
Mailing Address - Street 1:7015 ALMEDA RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2101
Mailing Address - Country:US
Mailing Address - Phone:713-520-6875
Mailing Address - Fax:
Practice Address - Street 1:7015 ALMEDA RD
Practice Address - Street 2:SUITE 3
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2101
Practice Address - Country:US
Practice Address - Phone:832-706-3811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health