Providence Home Dialysis LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

PROVIDENCE HOME DIALYSIS LLC

Practice address

7737 Beechnut St Ste 102
Houston, TX 77074-3109

Phone

(713) 861-7500

Fax

(713) 861-7502

NPI assigned

Mar 28, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shonta Williams

Title

Coo

Phone

(346) 388-0656

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1720782410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7737 BEECHNUT ST STE 102",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770743109",
            "telephone_number": "713-861-7500",
            "fax_number": "713-861-7502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7737 BEECHNUT ST STE 102",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770743109",
            "telephone_number": "713-861-7500",
            "fax_number": "713-861-7502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HOME DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-28",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "SHONTA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "346-388-0656"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Providence ER of Clearlake, PLLC (Houston Medical ER)
• Providence ER of Northwest PLLC (Cypress Creek ER)
• Providence Everly Haven Home Healthcare, LLC
• Providence Family Practice PA
• Providence Healthcare of TX (PHT Heal)
• Providence Hospice Care Inc
• Providence Hospital of North Houston LLC
• Providence Pharmacy & Medical Supplies, Inc. (Providence Pharmacy)
• Providence Physician Associates (Brazos Urgent Care)
• Providence RX Pharmacy LLC

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Houston, TX
• Providers in Houston, TX by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.