Provider Demographics
NPI:1912520412
Name:SINGULAR LUXURY DIALYSIS PEARLAND LLC
Entity Type:Organization
Organization Name:SINGULAR LUXURY DIALYSIS PEARLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ENABE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-628-2646
Mailing Address - Street 1:11161 SHADOW CREEK PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7286
Mailing Address - Country:US
Mailing Address - Phone:832-905-6200
Mailing Address - Fax:832-850-6482
Practice Address - Street 1:11161 SHADOW CREEK PKWY STE 101
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7286
Practice Address - Country:US
Practice Address - Phone:346-409-1192
Practice Address - Fax:713-413-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2021-03-04
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
TX110555OtherTEXAS STATE DEPARTMENT OF HEALTH SERVICES