Organization
PORTOLA DIALYSIS LLC
Active
Other names
Mid Valley PD Home Training
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
1205 N MICHIGAN AVE, SAGINAW, MI 48602-4729
(989) 771-9381
(989) 771-9407
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4514
(866) 594-9961
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
—
1861947020
—
MI
Enumeration date
08/17/2016
Last updated
07/29/2020
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