Organization
DVA HEALTHCARE OF NEW LONDON LLC
Active
Other names
New London 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
5 SHAWS CV, STE 100, NEW LONDON, CT 06320-4974
(860) 701-1357
(860) 444-0802
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
0255
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004202769
—
CT
Enumeration date
02/24/2006
Last updated
11/12/2024
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