SHADOW DIALYSIS LLC NPI 1780836684

NPI Information

  • NPI: 1780836684
  • Provider Name: SHADOW DIALYSIS LLC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • Doing Business As: ANTELOPE DIALYSIS CENTER
  • CLIA Number: 05D0930590
  • Address: 6406 TUPELO DR
    STE A
    CITRUS HEIGHTS, CA
    ZIP 95621
  • Phone: (916) 721-1800

Map and Directions

Get Directions

NPI Details

SHADOW DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Citrus Heights, CA. SHADOW DIALYSIS LLC NPI is 1780836684. The provider is registered as an organization entity type.
The provider Is Doing Business As Antelope Dialysis Center.

The provider's business location address is:

6406 TUPELO DR
STE A
CITRUS HEIGHTS, CA
ZIP 95621-780
Phone: (916) 721-1800
Fax: (916) 721-4376

The provider's authorized official is Samuel T. 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 05D0930590 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/22/2008 and was last updated on 7/16/2024.

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) Treatment110000455CALIFORNIAYes

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
11780836684MEDICAIDCALIFORNIA

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: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI