Organization
RENAL LIFE LINK INC
Active
Other names
DAVENPORT 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
45597 HIGHWAY 27 RIDGEVIEW PLAZA, DAVENPORT, FL 33897-4519
(863) 419-7408
(863) 420-9165
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
—
890850800
—
FL
Enumeration date
04/21/2006
Last updated
04/11/2025
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