Centennial LV LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

CENTENNIAL LV LLC

Doing business as

Centennial Dialysis Center

Practice address

8775 W Deer Springs Way
Las Vegas, NV 89149-0416

Phone

(702) 395-2488

Fax

(702) 645-5007

NPI assigned

Nov 16, 2007

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• Centennial Dialysis Center Doing business as

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Listed as

DaVita Centennial Dialysis CenterCCN 292531

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Jul 18, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

20

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

CLIA laboratory certificates

Member of 2

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

• Total Renal Care Inc

  dba Parkland Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Parkland, WA
  • NPI 1881987485

  Member Of

  NPD member
• Total Renal Care, Inc.

  dba Walker South Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Walker, LA
  • NPI 1841682200

  Member Of

  NPD member

Affiliated clinicians 2

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

• Adin Boldur, MD

  • Nephrology Physician
  • Las Vegas, NV
  • NPI 1619914066

  Dialysis facility

  Care Compare affiliation Name & address match
• Phillip Ribeiro, MD

  • Nephrology Physician
  • Las Vegas, NV
  • NPI 1972920023

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766966400000",
    "number": "1639350804",
    "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": "8775 W DEER SPRINGS WAY",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891490416",
            "telephone_number": "702-395-2488",
            "fax_number": "702-645-5007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTENNIAL LV LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-16",
        "last_updated": "2025-12-29",
        "certification_date": "2025-12-29",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639350804",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centennial Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Centennial Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Centennial Hills Hospital Medical Center
• Centennial Hills Hospital Medical Center
• Centennial Hills Hospital Medical Center (ER at West Craig Road)
• Centennial Hills Mental Health LLC
• Centennial Hills Urgent Care Medical Group
• Centennial Medical Group LLP
• Centennial Medical Group LLP
• Centennial Medical Imaging, LLC
• Centennial Pain Relief Network, LLC (Centennial Spine and Pain Center)
• Centennial Pediatrics

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 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.