| Organization Name: | END STAGE RENAL DISEASE HOME CARE PROVIDER AGENCY |
| NPI Number: | 1083950984 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM HENRY DAVIS (OWNER/SUPPLY) |
| Mailing Address: | 22356 W Lasso Ln Buckeye |
| State: | AZ US |
| Postal Code: | 853265979 |
| Phone Number: | 6232102710 |
| Fax Number: | |
| NPI Enumeration Date: | 12/20/2012 |
| NPI Last Update Date: | 09/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BD1200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Dialysis Equipment & Supplies |
| Taxonomy Definition: | |