Provider Demographics
NPI:1568037349
Name:SIMPLY KIDNEY CARE, LLC
Entity Type:Organization
Organization Name:SIMPLY KIDNEY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
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:346-307-7767
Mailing Address - Fax:346-307-4849
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:346-307-7767
Practice Address - Fax:346-307-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment