Organization
DAVITA RIVERSIDE LLC
Active
Other names
Lake Elsinore 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
32291 MISSION TRL, BLDG S, LAKE ELSINORE, CA 92530-2310
(951) 674-5050
(951) 674-5570
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
240000841
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205895869
—
CA
Enumeration date
03/22/2006
Last updated
12/24/2024
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