Organization
MULGEE DIALYSIS LLC
Active
Other names
Hawthorne 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
14204 PRAIRIE AVE, HAWTHORNE, CA 90250-7908
(310) 349-1174
(310) 349-1903
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
550002530
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710229794
—
CA
Enumeration date
03/18/2013
Last updated
01/26/2026
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