Provider Demographics
NPI:1659677987
Name:ST. BERNADETTE OF LOURDES DIALYSIS AND EDUCATION CENTER,LLC.
Entity Type:Organization
Organization Name:ST. BERNADETTE OF LOURDES DIALYSIS AND EDUCATION CENTER,LLC.
Other - Org Name:SBLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE ANN
Authorized Official - Middle Name:ALMAZAR
Authorized Official - Last Name:YAP
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CHN
Authorized Official - Phone:713-433-7252
Mailing Address - Street 1:12224 ALMEDA RD STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-3735
Mailing Address - Country:US
Mailing Address - Phone:713-433-7252
Mailing Address - Fax:713-433-2222
Practice Address - Street 1:12224 ALMEDA RD
Practice Address - Street 2:STE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-3735
Practice Address - Country:US
Practice Address - Phone:713-433-7252
Practice Address - Fax:713-433-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment