Organization
CHANNEL DIALYSIS LLC
Active
Other names
Bermuda Dunes 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
78030 WILDCAT DR, STE 101, PALM DESERT, CA 92211-1116
(760) 345-5115
(760) 360-3110
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
550001918
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417245259
—
CA
Enumeration date
07/14/2011
Last updated
10/28/2024
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