Organization
KIDNEY LIFE, LLC
Active
Other names
East Orange Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
14-20 PROSPECT ST, EAST ORANGE, NJ 07017-2238
(973) 672-2025
(973) 675-1381
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
22214
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0981745
—
NJ
Enumeration date
07/02/2006
Last updated
03/11/2025
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