Organization
LIGHTHOUSE DIALYSIS LLC
Active
Other names
Lemoore Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (SR DIR LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1345 W BUSH ST, LEMOORE, CA 93245-3303
(559) 924-3175
(559) 924-2485
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 238-3085
(800) 268-9682
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
550001590
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639474265
—
CA
Enumeration date
01/12/2011
Last updated
09/11/2023
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