Provider Demographics
NPI:1902587769
Name:PINON DIALYSIS LLC
Entity Type:Organization
Organization Name:PINON DIALYSIS LLC
Other - Org Name:RIALTO HOME TRAINING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, LICENSURE & CERTIFI
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-341-6641
Mailing Address - Street 1:5200 VIRGINIA WAY
Mailing Address - Street 2:ATTN: L&C DEPT
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7569
Mailing Address - Country:US
Mailing Address - Phone:615-341-6282
Mailing Address - Fax:866-510-6389
Practice Address - Street 1:1275 W FOOTHILL BLVD STE 1
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-4748
Practice Address - Country:US
Practice Address - Phone:615-341-6282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment