MEDICARE: CHERAW DIALYSIS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	550003151	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1124443791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHERAW DIALYSIS LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L&C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3380 SAN PABLO DAM RD STE C-D
Second Line	:
City	:	SAN PABLO
State	:	CA
Zip	:	94803-7218
Country	:	US
Telephone Number	:	510-262-9230
Fax Number	:	510-262-9203

Authorized Official
Title or Position	:	VP, LICENSURE & CERTIFICATION
Name	:	SAMUEL T. WEY
Credential	:
Telephone Number	:	615-341-6641

Provider Enumeration Date	:	02/19/2014
Last Update Date	:	10/07/2024

Similar Medicare Providers

1457333031 — MR. GARY W PRESCOTT CO/LPO
Practice Location Address:

6715 SAN PEDRO
SAN ANTONIO, TX
78216-7218

Practice Phone: 210-224-0726
Practice Fax: 210-341-3164

1447236864 — DR. LUIS ROBERTO PINERO II M.D.
Practice Location Address:

1789 CALLE CLAVEL , MANSIONES DE RIO PIEDRAS
SAN JUAN, PR
00926-7218

Practice Phone: 787-649-9275
Practice Fax: 787-761-7976

1275501843 — ROBIN A BERTHELET PT
Practice Location Address:

1560 VIA RISA
SAN MARCOS, CA
92078-7218

Practice Phone: 858-205-8250
Practice Fax:

1326075102 — PRESCOTTS LIMBS & BRACES, INC.
Practice Location Address:

6715 SAN PEDRO AVE
SAN ANTONIO, TX
78216-7218

Practice Phone: 210-224-0726
Practice Fax: 210-341-3164

1295527208 — MOHAMED ALLIE KRAYEM
Practice Location Address:

7218 SAN RAMON DR
HOUSTON, TX
77083-4518

Practice Phone: 313-980-8263
Practice Fax:

1770292831 — GEORGE JORDAN III
Practice Location Address:

4892 SAN PABLO DAM RD
EL SOBRANTE, CA
94803-3222

Practice Phone: 510-223-4236
Practice Fax:

Directions to “CHERAW DIALYSIS LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.