Provider Demographics
NPI:1841705217
Name:SOUTH TEXAS HOME HEMODIALYSIS LLC
Entity type:Organization
Organization Name:SOUTH TEXAS HOME HEMODIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ABHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-331-1112
Mailing Address - Street 1:3571 W WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3461
Mailing Address - Country:US
Mailing Address - Phone:214-331-1112
Mailing Address - Fax:214-331-1115
Practice Address - Street 1:3571 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3461
Practice Address - Country:US
Practice Address - Phone:214-331-1112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
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
1821477415OtherLIBERTY AT HOME DIALYSIS, LLC