Organization
LAKESHORE DIALYSIS LLC
Active
Other names
Five Rivers 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
4750 N MAIN ST, DAYTON, OH 45405-5021
(937) 278-5139
(937) 278-5722
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
—
0099627
—
OH
Enumeration date
03/01/2013
Last updated
09/05/2025
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