Organization
SHINING STAR DIALYSIS INC
Active
Other names
Bricktown Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
525 JACK MARTIN BLVD, STE 200, BRICK, NJ 08724-7737
(732) 836-9669
(732) 836-9709
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 341-6410
(888) 662-8259
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
22882
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017183
—
NJ
Enumeration date
07/10/2006
Last updated
01/12/2021
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