Organization
ROUSHE DIALYSIS LLC
Active
Other names
Mishawaka 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
1420 TRINITY PL, MISHAWAKA, IN 46545-5005
(574) 231-7204
(574) 231-7205
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
—
201228810A
—
IN
Enumeration date
07/17/2013
Last updated
05/23/2024
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