Provider Demographics
NPI:1487461539
Name:HOMECARE HOME HEMODIALYSIS, PLLC
Entity type:Organization
Organization Name:HOMECARE HOME HEMODIALYSIS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CCHT
Authorized Official - Phone:480-578-4536
Mailing Address - Street 1:17677 W COUNTRY CLUB TER
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85387-4026
Mailing Address - Country:US
Mailing Address - Phone:480-578-4536
Mailing Address - Fax:
Practice Address - Street 1:6121 N 52ND PL
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-5105
Practice Address - Country:US
Practice Address - Phone:480-578-3426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251F00000XAgenciesHome Infusion
No251E00000XAgenciesHome HealthGroup - Single Specialty
No2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Single Specialty