Healthcare Provider Details

I. General information

NPI: 1366933749
Provider Name (Legal Business Name): WOODLAND HILLS DIALYSIS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5939 CANOGA AVE
WOODLAND HILLS CA
91367
US

IV. Provider business mailing address

4000 COVER ST STE 100
LONG BEACH CA
90808-1790
US

V. Phone/Fax

Practice location:
  • Phone: 562-421-2690
  • Fax: 562-421-2060
Mailing address:
  • Phone: 562-421-2690
  • Fax: 562-421-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LAWRENCE W JONES
Title or Position: MANAGER
Credential:
Phone: 562-421-2690