Organization
OLIVE DIALYSIS LLC
Active
Other names
South Gate Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
9848 ATLANTIC AVE, SOUTH GATE, CA 90280-5219
(323) 569-1035
(323) 569-1790
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184004137
—
CA
Enumeration date
06/04/2015
Last updated
08/14/2024
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