Organization Active NPI

Millonee Dialysis LLC

Doing business as Progress Avenue Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Harrisburg, PA
National Provider Identifier
1356897938
Registry record updated Oct 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
MILLONEE DIALYSIS LLC
Doing business as
Progress Avenue Dialysis
Practice address
4390 Sturbridge Dr
Harrisburg, PA 17110-3668
Phone
(717) 545-2805
Fax
(717) 545-3987
NPI assigned
Sep 1, 2016
Last updated
Oct 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Samuel Wey
Title
VP Licensure & Certification
Phone
(615) 341-6641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary

Addresses

Primary practice location

4390 Sturbridge Dr
Harrisburg, PA 17110-3668

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
103500274MedicaidPA

Other names 1

  • Progress Avenue Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161013000737 PA Part A Provider - End-Stage Renal Disease Facility (ESRD) 0749578474 Practice locations: Harrisburg, PA

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Progress Avenue DialysisCCN 392858
Overall star rating
2.0 of 5
Ownership
Profit
Certified
May 3, 2017
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
14

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2123295Progress Avenue Dialysis4390 Sturbridge Drive, Harrisburg, PA 17110Certificate of waiverDec 17, 2026

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4390 Sturbridge Dr
Harrisburg, PA 17110
Phone (717) 545-2805

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760486400000",
    "number": "1356897938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4390 STURBRIDGE DR",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171103668",
            "telephone_number": "717-545-2805",
            "fax_number": "717-545-3987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLONEE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103500274",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Progress Avenue Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Progress Avenue Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harrisburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.