Organization
CANYON COUNTRY DIALYSIS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY GREEN (SECRETARY)
(562) 421-2690
Entity
Organization
Contact information
Practice address
18520 VIA PRINCESSA, BLDG C-1, SUITE A, CANYON COUNTRY, CA 91387-8326
(661) 298-5300
(661) 424-9733
Mailing address
4000 COVER ST, STE 100, LONG BEACH, CA 90808-1790
(562) 421-2690
(562) 421-2060
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
550000035
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CDC52547F
—
CA
Enumeration date
01/27/2006
Last updated
11/29/2016
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