Organization
SOUTH FORK DIALYSIS LLC
Active
Organization
SOUTH FORK DIALYSIS LLC
Active
Other names
Herndon Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
560 E HERNDON AVE, STE 101, FRESNO, CA 93720-2907
(559) 432-5278
(559) 435-1422
Mailing address
5200 VIRGINIA WAY, 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
550002083
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659647808
—
CA
Enumeration date
03/31/2012
Last updated
02/17/2022
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