Provider Demographics
NPI:1487254868
Name:FREEDOM DIALYSIS ONE INC
Entity type:Organization
Organization Name:FREEDOM DIALYSIS ONE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MANAF
Authorized Official - Middle Name:
Authorized Official - Last Name:ALROUMOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-300-3484
Mailing Address - Street 1:7746 HIGHWAY 6 STE C
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4780
Mailing Address - Country:US
Mailing Address - Phone:212-300-3484
Mailing Address - Fax:
Practice Address - Street 1:7746 HIGHWAY 6 STE C
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4780
Practice Address - Country:US
Practice Address - Phone:212-300-3484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1548350614Medicaid