Flagler Dialysis LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

240000808 Issued in CA

Legal business name

FLAGLER DIALYSIS LLC

Doing business as

Moreno Valley Dialysis

Practice address

22620 Goldencrest Dr
Ste 101
Moreno Valley, CA 92553-9032

Phone

(951) 656-3804

Fax

(951) 656-7508

NPI assigned

Sep 19, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John D. Winstel

Title

Cheif Accounting Officer

Phone

(253) 733-4501

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Moreno Valley Dialysis Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Burlington, WA
  • NPI 1932595584

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613520000000",
    "number": "1346590106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT.",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-341-6793",
            "fax_number": "877-790-2174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22620 GOLDENCREST DR",
            "address_2": "STE 101",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925539032",
            "telephone_number": "951-656-3804",
            "fax_number": "951-656-7508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLAGLER DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-19",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CHEIF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4501"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "CA",
            "license": "240000808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346590106",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moreno Valley Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Moreno Valley Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Firstsight Vison Services, Inc.
• Brenda Fisher
• Robin Fisher, DO
• Sarah Salome Fisher, LMFT
• Joseph Fiske, DO
• James William Fletcher IV, CPHT
• Bianca Flores
• Desirae Flores, ADC
• Irene Love Flores
• Kateri Flores

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.