Provider Demographics
NPI:1821509696
Name:GLOBAL HOME DIALYSIS
Entity Type:Organization
Organization Name:GLOBAL HOME DIALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-816-1487
Mailing Address - Street 1:11611 WEST AIRPORT BLVD.,
Mailing Address - Street 2:STE H #106
Mailing Address - City:MEADOWS PLACE
Mailing Address - State:TX
Mailing Address - Zip Code:77477
Mailing Address - Country:US
Mailing Address - Phone:281-980-0787
Mailing Address - Fax:346-299-9161
Practice Address - Street 1:12823 CAPRICORN STREET
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477
Practice Address - Country:US
Practice Address - Phone:281-980-0787
Practice Address - Fax:346-299-9161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011843251E00000X
251F00000X, 253Z00000X, 261QE0700X, 332BD1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0103077OtherDURABLE MEDICAL EQUIPMENT
TX011843OtherTEXAS DEPARTMENT OF AGING AND DISABILITY SERVICES