Organization
BOHAMA DIALYSIS LLC
Active
Other names
Rancho Cucamonga Home Training
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
8219 ROCHESTER AVE, STE 120, RANCHO CUCAMONGA, CA 91730-0723
(909) 466-5489
(909) 477-2098
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
—
1497095905
—
CA
Enumeration date
02/20/2013
Last updated
03/29/2024
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