Provider Demographics
NPI:1649275504
Name:QUALITY DIALYSIS ONE, LLC
Entity type:Organization
Organization Name:QUALITY DIALYSIS ONE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-491-4009
Mailing Address - Street 1:13311 PIKE RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5111
Mailing Address - Country:US
Mailing Address - Phone:281-491-4009
Mailing Address - Fax:866-557-4844
Practice Address - Street 1:13311 PIKE RD STE E
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5111
Practice Address - Country:US
Practice Address - Phone:281-491-4009
Practice Address - Fax:866-557-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005985251E00000X, 253Z00000X, 261QE0700X, 251F00000X
TX1001352332BD1200X
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
TX0241291-01Medicaid
TX1001352OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES-DEVICE DISTRIBUTOR
TX019455OtherDMEPOS ACCREDIDIATION CERTIFICATION
TX005985OtherTEXAS DEPARTMENT OF AGING AND DISABILITY SERVICES HOME & SUPPORT SRVC AGENCY
TX005985OtherTEXAS DEPARTMENT OF AGING AND DISABILITY SERVICES HOME & SUPPORT SRVC AGENCY