Organization
TARGHEE DIALYSIS, LLC
Active
Other names
Eastgate Home Training
Organization subpart
No
Provider details
NPI number
Authorized official
SAM WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
4435 AICHOLTZ RD, STE 800B, CINCINNATI, OH 45245-1690
(513) 752-8301
(513) 752-8483
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
—
0366852
—
OH
Enumeration date
11/28/2018
Last updated
04/04/2024
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