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General NPI Number Information
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NPI Number | 1437397536
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Entity Type | Organization
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Legal Business Name | HAWAIIAN GARDENS DIALYSIS CENTER LLC
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 12191 226TH ST
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City | HAWAIIAN GARDENS
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State | CA
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Zip | 90716-1510
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Country | US
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Telephone | 562-421-4016
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Fax | 562-421-4652
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Provider Business Mailing Address
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Address Line | 5200 VIRGINIA WAY L&C DEPT
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City | BRENTWOOD
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State | TN
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Zip | 37027-7569
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Country | US
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Telephone | 615-341-6765
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Fax | 833-782-9089
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Authorized Official
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Title or Position | CHIEF ACCOUNTING OFFICER
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Name | JOHN D WINSTEL
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Credential |
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Telephone | 253-733-4501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 550001463
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License Number State | CA
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