Organization
WALTON DIALYSIS LLC
Active
Other names
Colton Ranch Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T. WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1405 W VALLEY BLVD, STE 100, COLTON, CA 92324-1963
(909) 783-7948
(909) 783-0125
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
550002975
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063838894
—
CA
Enumeration date
03/18/2014
Last updated
10/09/2024
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