Organization
CRYSTALS DIALYSIS LLC
Active
Organization
CRYSTALS DIALYSIS LLC
Active
Other names
Highland Ranch Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T. WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
7223 CHURCH ST, STE A14, HIGHLAND, CA 92346-6837
(909) 862-9670
(909) 862-9675
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
550001241
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942599592
—
CA
Enumeration date
04/05/2011
Last updated
08/20/2025
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