Organization
BLISS DIALYSIS LLC
Active
Other names
Berkshire Home Training
Organization subpart
No
Provider details
NPI number
Authorized official
SAM WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
4800 W SAN ANTONIO ST, STE 201, BROKEN ARROW, OK 74012-6156
(918) 249-9716
(918) 254-4173
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4268
(877) 238-0567
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
—
200518030A
—
OK
Enumeration date
10/26/2012
Last updated
11/03/2023
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