Organization
RENAL LIFE LINK INC
Active
Other names
Fairborn 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
3070 PRESIDENTIAL DR STE A, BEAVERCREEK, OH 45324-6273
(937) 426-6475
(937) 426-2436
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
0778DC
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2638908
—
OH
Enumeration date
04/20/2006
Last updated
09/24/2025
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