Organization
RENAL LIFE LINK INC
Active
Other names
Fox River 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
1910 RIVERSIDE DR, GREEN BAY, WI 54301-2319
(920) 436-4910
(920) 437-1718
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
—
1942264759
—
MI
05
—
1942264759
—
WI
Enumeration date
04/17/2006
Last updated
09/12/2024
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