Organization
CORAL DIALYSIS LLC
Active
Other names
Port City 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
1810 S FRESNO AVE, STOCKTON, CA 95206-1861
(209) 946-0738
(209) 946-0827
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
—
1437569514
—
CA
Enumeration date
04/29/2014
Last updated
09/20/2024
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