Provider Demographics
NPI:1124477112
Name:HOME DIALYSIS OF SANTA FE, LLC
Entity type:Organization
Organization Name:HOME DIALYSIS OF SANTA FE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BIJU
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-264-8120
Mailing Address - Street 1:PO BOX 22566
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-2566
Mailing Address - Country:US
Mailing Address - Phone:505-467-8199
Mailing Address - Fax:505-467-8519
Practice Address - Street 1:2904 RODEO PARK DR E STE 300A-1
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6305
Practice Address - Country:US
Practice Address - Phone:505-467-8199
Practice Address - Fax:505-467-8519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment