Provider Demographics
NPI:1467085167
Name:TANGLEWILDE DIALYSIS CENTER, LLC
Entity Type:Organization
Organization Name:TANGLEWILDE DIALYSIS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:MODUPE
Authorized Official - Last Name:ARISE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-605-3943
Mailing Address - Street 1:2620 TANGLEWILDE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3203
Mailing Address - Country:US
Mailing Address - Phone:832-605-3943
Mailing Address - Fax:713-588-8863
Practice Address - Street 1:2620 TANGLEWILDE ST STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3203
Practice Address - Country:US
Practice Address - Phone:832-605-3943
Practice Address - Fax:713-588-8863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment