End Stage Renal Disease Home Care Provider Agency

NPI #1083950984 in Buckeye, Arizona

Provider Information

NPI Number: 1083950984
Entity Type: Organization
Organization Name: End Stage Renal Disease Home Care Provider Agency
Primary Specialty: Durable Medical Equipment & Medical Supplies - Dialysis Equipment & Supplies
Enumeration Date: Dec 20, 2012
Last Updated: Sep 11, 2014

Practice Location

Address: 22356 W LASSO LN
City: Buckeye
State: Arizona
ZIP Code: 85326-5979
Phone: (623) 210-2710

Authorized Official

Name: MR. WILLIAM HENRY DAVIS JR.
Title: OWNER/SUPPLY
Phone: (414) 759-8587

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Durable Medical Equipment & Medical Supplies - Dialysis Equipment & Supplies — Dialysis Equipment & Supplies	332BD1200X	Primary

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