Provider Demographics
NPI:1518319706
Name:LONE STAR HOME DIALYSIS, INC.
Entity Type:Organization
Organization Name:LONE STAR HOME DIALYSIS, INC.
Other - Org Name:LONE STAR HOME DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, CFO
Authorized Official - Prefix:
Authorized Official - First Name:BALBEER
Authorized Official - Middle Name:K
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-799-7089
Mailing Address - Street 1:16903 RED OAK DR STE 100B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3917
Mailing Address - Country:US
Mailing Address - Phone:936-271-9442
Mailing Address - Fax:800-395-8956
Practice Address - Street 1:16903 RED OAK DR STE 100B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3917
Practice Address - Country:US
Practice Address - Phone:362-719-4429
Practice Address - Fax:800-395-8956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QE0700X
261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX607378362OtherBCBS