Organization
HUNTINGTON PARK DIALYSIS LLC
Active
Other names
Huntington Park 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
5942 RUGBY AVE., HUNTINGTON PARK, CA 90255-2803
(323) 585-7605
(323) 585-7635
Mailing address
5200 VIRGINIA WAY, L&C DEPT., BRENTWOOD, TN 37027-7569
(615) 238-3085
(800) 268-9682
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
550001465
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124261854
—
CA
Enumeration date
04/10/2009
Last updated
11/28/2023
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