Organization
ELLMAC DIALYSIS LLC
Active
Other names
Gloucester County Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1217 S BLACK HORSE PIKE, WILLIAMSTOWN, NJ 08094-1958
(856) 740-1890
(856) 740-1895
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0715522
—
NJ
Enumeration date
05/30/2019
Last updated
06/13/2024
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