Provider Demographics
NPI:1821273558
Name:ELIK DIALYSIS HOME THERAPY MANAGEMENT LLC
Entity Type:Organization
Organization Name:ELIK DIALYSIS HOME THERAPY MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BALBEER
Authorized Official - Middle Name:K
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE RN
Authorized Official - Phone:512-203-3826
Mailing Address - Street 1:311 RR 620 SOUTH
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-4747
Mailing Address - Country:US
Mailing Address - Phone:512-266-8135
Mailing Address - Fax:512-266-9266
Practice Address - Street 1:311 RR 620 SOUTH
Practice Address - Street 2:SUITE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-4747
Practice Address - Country:US
Practice Address - Phone:512-266-8135
Practice Address - Fax:512-266-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX537328163WD1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD1100XNursing Service ProvidersRegistered NurseDialysis, PeritonealGroup - Single Specialty