Provider Demographics
NPI:1073960845
Name:DSI APPLE VALLEY HOME DIALYSIS, LLC
Entity Type:Organization
Organization Name:DSI APPLE VALLEY HOME DIALYSIS, LLC
Other - Org Name:U.S. RENAL CARE VICTORVILLE HOME DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-736-2700
Mailing Address - Street 1:5851 LEGACY CIR STE 900
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5982
Mailing Address - Country:US
Mailing Address - Phone:214-736-2700
Mailing Address - Fax:214-736-2701
Practice Address - Street 1:17125 SILICA DR STE 102
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7715
Practice Address - Country:US
Practice Address - Phone:760-843-6752
Practice Address - Fax:760-843-8323
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. RENAL CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-20
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment