Organization
MIDWEST LEGACY CAPITAL LLC
Active
Other names
At Home Kidneycare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS A DUDLEY (CEO)
(920) 915-5202
Entity
Organization
Contact information
Practice address
W4233 STATE RD 54, BLACK CREEK, WI 54106-8633
(920) 915-5202
Mailing address
W4233 STATE RD 54, BLACK CREEK, WI 54106-8633
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Enumeration date
03/26/2018
Last updated
03/26/2018
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