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GARDEN GROVE HARBOR DIALYSIS
NPI 1619397700
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in Garden Grove, CA

Active since April 16, 2014CLIA 05D2083877 · Waiver
3/5
Overall Rating
13054 N HARBOR BLVD, GARDEN GROVE, CA 92843(714) 539-3395(714) 539-3467 Get Directions Write a Review

NPPES record last updated: June 7, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jun 7, 2024, May 17, 2021, Oct 7, 2019 and 1 more (4 updates tracked since 2016).

About Garden Grove Harbor Dialysis NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GARDEN GROVE HARBOR DIALYSIS (NPI 1619397700) is a healthcare organization registered as an end-stage renal disease (esrd) treatment in Garden Grove, California and active in the NPI registry since April 2014. The organization holds a CLIA Waiver certificate valid through September 14, 2026 and lists Samuel T. Wey, Vp, Licensure & Certification, as its authorized official.

NPPES Registry Identity

NPI1619397700
Entity TypeOrganization
Primary Taxonomy261QE0700X
Legal Business NameEDISTO DIALYSIS LLC
Location Address13054 N HARBOR BLVDGarden Grove, CA 92843-1744
Mailing Address5200 Virginia Way, L&c DeptBrentwood, TN 37027-7569
Phone(714) 539-3395
Fax(714) 539-3467
Organization SubpartNo
Authorized OfficialSamuel T. WeyVp, Licensure & Certification · (615) 341-6641
Enumeration DateApril 16, 2014
Last NPPES UpdateJune 7, 20244 updates tracked since enumeration
NPPES CertifiedJune 7, 2024
✔ NPI 1619397700 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · End-Stage Renal Disease (ESRD) TreatmentAmbulatory Health Care Facilities
Taxonomy Code261QE0700X
License✔ Licensed in CA · 550002921
13054 N HARBOR BLVD, Garden Grove, CA 92843
Open in Google Maps ↗

Other Names 1

Doing Business AsGarden Grove Harbor Dialysis

Other Identifiers 1

Medicaid1619397700CA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Ambetter from Superior HealthPlan, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2083877

Garden Grove Harbor Dialysis · Garden Grove, CA
Active · expires Sep 14, 2026
CLIA Number05D2083877
Laboratory TypeEnd Stage Renal Disease Dialysis Facility
Certificate Effective DateSeptember 15, 2024
Certificate Expiration DateSeptember 14, 2026
Laboratory DirectorHerbert Tiquia
Laboratory Phone(714) 539-3395
Laboratory LocationGarden Grove Harbor Dialysis13054 N Harbor Blvd, Garden Grove, CA 92843
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Dialysis Facility Quality Ratings CMS Care Compare

Quality ratings, services and patient survey results for RAI - Garden Grove Blvd - Garden Grove (CMS certification number 052617), from CMS Care Compare.

RAI - Garden Grove Blvd - Garden Grove

Dialysis facility · Garden Grove, CA
3/5 CMS RatingRating period January 2020 to December 2023
OwnershipProfit
ChainFresenius Medical Care
CMS Certification Number052617
ESRD NetworkNetwork 18
Hemodialysis Stations13
Medicare-Certified SinceJanuary 1, 1987
Location12555 Garden Grove Blvd., Suite 100Garden Grove, CA 92843 · Orange County
Phone(714) 741-7255
Services Offered
In-center hemodialysis

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Edisto Dialysis LLC's NPI number?

The NPI number for Edisto Dialysis LLC is 1619397700. It was assigned to this organization in the NPPES registry on April 16, 2014. The provider is doing business as Garden Grove Harbor Dialysis.

Where is Edisto Dialysis LLC located?

Edisto Dialysis LLC is located at 13054 N Harbor Blvd, Garden Grove, CA 92843. The listed phone number is (714) 539-3395.

What is Edisto Dialysis LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

Does Edisto Dialysis LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2083877) is associated with this NPI, valid through September 14, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is Edisto Dialysis LLC a Medicare-certified dialysis facility?

Yes. RAI - Garden Grove Blvd - Garden Grove is a Medicare-certified dialysis facility, certified since January 1, 1987.

What quality rating does Edisto Dialysis LLC have?

CMS rates RAI - Garden Grove Blvd - Garden Grove 3 out of 5 stars on Care Compare. The full measure detail is in the Dialysis Facility Quality section above.

What insurance does Edisto Dialysis LLC accept?

Health plans from Ambetter Health, Ambetter from Arizona Complete Health, Ambetter from Superior HealthPlan and UnitedHealthcare list Edisto Dialysis LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Edisto Dialysis LLC was last updated on June 7, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.