Provider Demographics
NPI:1639849920
Name:MEMORIAL HOME DIALYSIS, LLC
Entity Type:Organization
Organization Name:MEMORIAL HOME DIALYSIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLEAD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:806-283-7617
Mailing Address - Street 1:11980 KIRBY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-4860
Mailing Address - Country:US
Mailing Address - Phone:346-440-2800
Mailing Address - Fax:346-440-2900
Practice Address - Street 1:11980 KIRBY DR STE 102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-4860
Practice Address - Country:US
Practice Address - Phone:346-440-2800
Practice Address - Fax:346-440-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health