Provider Demographics
NPI:1437613916
Name:PREMIER HOME DIALYSIS SERVICES
Entity Type:Organization
Organization Name:PREMIER HOME DIALYSIS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ERIK
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:EMT/CPR/FF I&II
Authorized Official - Phone:602-448-5411
Mailing Address - Street 1:20118 N 67TH AVE STE 300-527
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4621
Mailing Address - Country:US
Mailing Address - Phone:602-448-5411
Mailing Address - Fax:
Practice Address - Street 1:20118 N 67TH AVE STE 300-527
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-4621
Practice Address - Country:US
Practice Address - Phone:602-448-5411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment