Provider Demographics
NPI:1467788547
Name:ELIK DIALYSIS HOME THERAPY-MEMORIAL INC DBA ELIK DIALYSIS HOME THERAPY
Entity Type:Organization
Organization Name:ELIK DIALYSIS HOME THERAPY-MEMORIAL INC DBA ELIK DIALYSIS HOME THERAPY
Other - Org Name:LICENSED HOME HEALTH SERVICES WITH HOME HEMODIALYSIS DESIGNATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BALBEER
Authorized Official - Middle Name:K
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:281-799-7089
Mailing Address - Street 1:1445 NORTH LOOP W STE 720
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1676
Mailing Address - Country:US
Mailing Address - Phone:713-861-7500
Mailing Address - Fax:
Practice Address - Street 1:1445 NORTH LOOP W STE 720
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1676
Practice Address - Country:US
Practice Address - Phone:713-861-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012755251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health