Provider Demographics
NPI:1598223448
Name:LONE STAR HOME DIALYSIS LIMITED
Entity Type:Organization
Organization Name:LONE STAR HOME DIALYSIS LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BALBEER
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-799-7089
Mailing Address - Street 1:150 PINE FOREST DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-5302
Mailing Address - Country:US
Mailing Address - Phone:936-271-9442
Mailing Address - Fax:800-395-8956
Practice Address - Street 1:150 PINE FOREST DR STE 102
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-5302
Practice Address - Country:US
Practice Address - Phone:936-271-9442
Practice Address - Fax:800-395-8956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017785OtherTEXAS HEALTH AND HUMAN SERVICES (DADS)