OLIVE DIALYSIS LLC NPI 1184004137

NPI Information

  • NPI: 1184004137
  • Provider Name: OLIVE DIALYSIS LLC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • Doing Business As: SOUTH GATE DIALYSIS
  • CLIA Number: 05D2100865
  • Address: 9848 ATLANTIC AVE
    SOUTH GATE, CA
    ZIP 90280
  • Phone: (323) 569-1035

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NPI Details

OLIVE DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in South Gate, CA. OLIVE DIALYSIS LLC NPI is 1184004137. The provider is registered as an organization entity type.
The provider Is Doing Business As South Gate Dialysis.

The provider's business location address is:

9848 ATLANTIC AVE
SOUTH GATE, CA
ZIP 90280-219
Phone: (323) 569-1035
Fax: (323) 569-1790

The provider's authorized official is Samuel Wey .
The authorized official title is Vp Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 05D2100865 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/4/2015 and was last updated on 8/14/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11184004137MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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