Provider Demographics
NPI:1790970630
Name:ALLSTATE DIALYSIS CENTER INCORPORATED
Entity Type:Organization
Organization Name:ALLSTATE DIALYSIS CENTER INCORPORATED
Other - Org Name:HILLCROFT DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-772-0992
Mailing Address - Street 1:6015 HILLCROFT ST
Mailing Address - Street 2:STE. 3000
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1019
Mailing Address - Country:US
Mailing Address - Phone:713-772-0992
Mailing Address - Fax:713-776-3271
Practice Address - Street 1:6015 HILLCROFT ST
Practice Address - Street 2:STE. 3000
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1019
Practice Address - Country:US
Practice Address - Phone:713-772-0992
Practice Address - Fax:713-776-3271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2010-01-15
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
67-2623Medicare PIN