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CHANNEL DIALYSIS LLC NPI 1417245259


NPI Information

NPI: 1417245259
Provider Name: CHANNEL DIALYSIS LLC

Doing Business As: BERMUDA DUNES DIALYSIS

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 05D2033793

Address:
78030 WILDCAT DR
STE 101
PALM DESERT, CA
ZIP 92211
Phone: (760) 345-5115
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CHANNEL DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Palm Desert, CA. CHANNEL DIALYSIS LLC NPI is 1417245259. The provider is registered as an organization entity type.
The provider Is Doing Business As Bermuda Dunes Dialysis.

The provider's business location address is:

78030 WILDCAT DR
STE 101
PALM DESERT, CA
ZIP 92211-116
Phone: (760) 345-5115
Fax: (760) 360-3110

The provider's authorized official is John D Winstel .
The authorized official title is Chief Accounting Officer and has the following contact phone number (253) 733-4501.

The CLIA number assigned to this NPI record is 05D2033793 - end stage renal disease dialysis with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/14/2011 and was last updated on 2/17/2022.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment550001918CALIFORNIAYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11417245259MEDICAIDCALIFORNIA

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: 11/14/2023

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