Crystals Dialysis LLC
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Highland, CA
NPI 1942599592 · NPPES record last updated Aug 20, 2025
Key facts
- NPI
- 1942599592
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- License
- 550001241 (CA)
- Legal business name
- CRYSTALS DIALYSIS LLC
- Practice address
- 7223 Church St
Ste A14
Highland, CA 92346-6837 - Phone
- (909) 862-9670
- Fax
- (909) 862-9675
- NPI assigned
- Apr 5, 2011
- Organization subpart
- No
Authorized official
- Name
- Samuel T. Wey
- Title
- VP, Licensure & Certification
- Phone
- (615) 341-6641
Member of 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110808000345 | CA | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 2163691213 | Practice locations: Highland, CA |
National Provider Directory
Locations
7223 Church St
Ste A14
Highland, CA 92346
Phone (253) 382-1919
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 550001241 | CA | Yes |
Addresses
Primary practice location
7223 Church St
Ste A14
Highland, CA 92346-6837
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942599592 | Medicaid | CA |
Other names
- Highland Ranch Dialysis Center
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All providers in Highland, CA · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.