Provider Demographics
NPI:1407546682
Name:ARTISTIC HOME DIALYSIS, LLC
Entity Type:Organization
Organization Name:ARTISTIC HOME DIALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOVETH
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:IGBRU
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:832-627-8250
Mailing Address - Street 1:4220 CARTWRIGHT RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5307
Mailing Address - Country:US
Mailing Address - Phone:832-627-8250
Mailing Address - Fax:832-804-9338
Practice Address - Street 1:4220 CARTWRIGHT RD STE 103
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5307
Practice Address - Country:US
Practice Address - Phone:832-627-8250
Practice Address - Fax:832-804-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care