Provider Demographics
NPI:1417457722
Name:SIMPLY DIALYSIS AND HOME HEALTH LLC
Entity Type:Organization
Organization Name:SIMPLY DIALYSIS AND HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONAVENTURA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:CELESTINE
Authorized Official - Suffix:
Authorized Official - Credentials:LBSW
Authorized Official - Phone:346-307-7767
Mailing Address - Street 1:21925 FRANZ RD STE 401
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-3723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21925 FRANZ RD STE 401
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-3723
Practice Address - Country:US
Practice Address - Phone:713-203-8053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH964KOtherBLUE CROSS BLUE SHEILD OF TEXAS