ROOSE DIALYSIS LLC NPI 1790929826

NPI Information

ROOSE DIALYSIS LLC is an end-stage renal disease (esrd) treatment clinic center in Stockton, CA. ROOSE DIALYSIS LLC NPI is 1790929826. The provider is registered as an organization entity type.
The provider Is Doing Business As Stockton Kidney Center.

The provider's business location address is:

1523 E MARCH LN
STE 200
STOCKTON, CA
ZIP 95210-607
Phone: (209) 472-3300
Fax: (209) 472-0900

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 05D1104152 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/20/2009 and was last updated on 3/14/2024.

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:

Other Identifiers

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