Organization
OGANO DIALYSIS LLC
Active
Other names
Chantilly 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
14225 SULLYFIELD CIR STE A, CHANTILLY, VA 20151-1688
(703) 263-0215
(703) 378-7692
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPARTMENT, BRENTWOOD, TN 37027-7569
(615) 320-4214
(866) 944-3352
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
—
1790213593
—
VA
Enumeration date
05/24/2017
Last updated
01/11/2024
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