Organization
RENAL LIFE LINK INC
Active
Other names
Old Forge Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
325 S MAIN ST, OLD FORGE, PA 18518-1677
(570) 457-3174
(570) 457-3313
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
—
1014890420002
—
PA
Enumeration date
04/05/2006
Last updated
05/01/2024
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