Organization
COAST DIALYSIS LLC
Active
Other names
Charles Towne Home Program
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1964 ASHLEY RIVER RD, SUITE D-2, CHARLESTON, SC 29407-4782
(843) 573-8767
(843) 573-2394
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
ERD-0197
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RE0035
—
SC
Enumeration date
09/02/2011
Last updated
04/19/2024
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