Organization
FLAGLER DIALYSIS LLC
Active
Other names
Moreno Valley Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D. WINSTEL (CHEIF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
22620 GOLDENCREST DR, STE 101, MORENO VALLEY, CA 92553-9032
(951) 656-3804
(951) 656-7508
Mailing address
5200 VIRGINIA WAY, L&C DEPT., BRENTWOOD, TN 37027-7569
(615) 341-6793
(877) 790-2174
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
240000808
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346590106
—
CA
Enumeration date
09/19/2012
Last updated
02/17/2021
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