Provider Demographics
NPI:1851818298
Name:DECATUR HOME DIALYSIS LLC
Entity Type:Organization
Organization Name:DECATUR HOME DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITZSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-673-5245
Mailing Address - Street 1:4930 BROOKSVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9275
Mailing Address - Country:US
Mailing Address - Phone:940-627-0009
Mailing Address - Fax:888-788-1449
Practice Address - Street 1:2301 S FM 51
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3865
Practice Address - Country:US
Practice Address - Phone:940-627-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-26
Last Update Date:2022-03-14
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
TX3971400-01Medicaid
TX74-2523OtherMEDICARE