Organization
LIVARY DIALYSIS LLC
Active
Other names
Grants Lake 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
16035 LEXINGTON BLVD, SUGAR LAND, TX 77479-2316
(832) 783-9090
(888) 835-3621
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
—
432295001
—
TX
Enumeration date
04/02/2021
Last updated
07/29/2025
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