Provider Demographics
NPI:1609290329
Name:LDHV, LLC
Entity Type:Organization
Organization Name:LDHV, LLC
Other - Org Name:LIBERTY DIALYSIS - HUNTSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:540 INTERSTATE 45 S STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-5721
Mailing Address - Country:US
Mailing Address - Phone:936-295-3180
Mailing Address - Fax:936-295-3542
Practice Address - Street 1:540 INTERSTATE 45 S STE A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5721
Practice Address - Country:US
Practice Address - Phone:936-295-3180
Practice Address - Fax:936-295-3542
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-17
Last Update Date:2023-10-14
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
TX672744Medicare Oscar/Certification