Organization
BROOKSTONE DIALYSIS LLC
Active
Parent organization
DAVITA INC
Other names
Liberty Park Dialysis
Organization subpart
Yes
Provider details
NPI number
Legal business name
DAVITA INC
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 320-4414
Entity
Organization
Contact information
Practice address
15 CARBON PL, JERSEY CITY, NJ 07305-5295
(551) 285-1016
(551) 285-1343
Mailing address
5200 VIRGINIA WAY, L AND C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4414
(866) 865-2884
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
01/10/2023
Last updated
01/03/2024
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