Organization
PRUNEAU DIALYSIS, LLC
Active
Other names
Ocala West Home Training
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
8615 SW 103RD STREET RD, OCALA, FL 34481-9622
(352) 854-3099
(352) 854-3480
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
—
014725500
—
FL
Enumeration date
09/26/2014
Last updated
08/21/2024
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