Organization
DESOTO DIALYSIS LLC
Active
Other names
Lucas County Home Training
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
2702 NAVARRE AVE, STE 203, OREGON, OH 43616-3224
(419) 691-1514
(419) 691-1594
Mailing address
5200 VIRGINIA WAY, ATT: 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
—
0088755
—
OH
05
—
1285916106
—
OH
Enumeration date
09/16/2011
Last updated
03/29/2024
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