Provider Demographics
NPI:1164834099
Name:FIVE STAR DIALYSIS, LLC
Entity Type:Organization
Organization Name:FIVE STAR DIALYSIS, LLC
Other - Org Name:FIVE STAR HOME DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR / CFO
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:GERALDO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-436-1811
Mailing Address - Street 1:11021 SHADOW CREEK PKWY STE 121-300
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7401
Mailing Address - Country:US
Mailing Address - Phone:713-436-1811
Mailing Address - Fax:281-506-8751
Practice Address - Street 1:3327 S SAM HOUSTON PKWY E STE 200B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-6549
Practice Address - Country:US
Practice Address - Phone:713-436-1811
Practice Address - Fax:281-506-8751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
251F00000X, 332BD1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016415OtherLICENSED HCSSA