Organization
KINGSTON DIALYSIS LLC
Active
Other names
Mile High Home Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1750 PIERCE ST STE A, LAKEWOOD, CO 80214
(303) 232-0939
(303) 274-6096
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
12R950
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36032395
—
CO
Enumeration date
09/14/2015
Last updated
06/20/2024
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