Organization
RENAL TREATMENT CENTERS-ILLINOIS INC
Active
Other names
Shenandoah Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
300 PERSHING AVE, SHENANDOAH, IA 51601-2355
(712) 246-5220
(712) 246-5226
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
—
0625277
—
IA
05
—
10025304400
—
NE
05
—
1902873656
—
MO
Enumeration date
03/01/2006
Last updated
04/18/2025
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