Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391

Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 852586 (X3) Date Survey Completed 07/09/2025
Name of Provider or Supplier Dialysis Care Center Gwinnett, Llc Street Address, City, State 558 Old Norcross Road, Suite 104, Lawrenceville, GA
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
V0000 A Recertification survey was conducted at Dialysis Care Center Gwinnett, LLC from July 7, 2025 through July 9, 2025. The survey revealed that the facility was not in compliance with 42 CFR Part 494.40 - Water and Dialysate Quality and 42 CFR Part 494.180 - Governance, for End Stage Renal Disease Facilities. The following standard level deficiencies were also cited which resulted from the facility's noncompliance related to the survey: