Basic Information
| Provider Information | |||||||||
| NPI: | 1811165087 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | US RENAL CARE HOME THERAPIES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 251549 | ||||||||
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| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750251500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709315400 | ||||||||
| FaxNumber: | 8709315418 | ||||||||
| Practice Location | |||||||||
| Address1: | 8515 FANNIN ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770544811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136682744 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2008 | ||||||||
| LastUpdateDate: | 09/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | WEINBERG | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VP, GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 2147362730 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | US RENAL CARE INC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
ID Information
| ID | Type | State | Issuer | Description | 024100 | 01 | TX | KIDNEY HEALTH CARE | OTHER | 1984718-01 | 05 | TX | MEDICAID |