Organization
SHAWANO DIALYSIS, LLC
Active
Other names
James River Home 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
13859 VILLAGE PLACE DR, MIDLOTHIAN, VA 23114-3503
(804) 378-2170
(804) 378-2175
Mailing address
5200 VIRGINIA WAY, L & C DEPARTMENT, 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
—
1720552110
—
VA
Enumeration date
01/18/2019
Last updated
02/27/2026
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