NPIMap

Organization Active NPI

Renal Life Link Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Beavercreek, OH
National Provider Identifier
1689639502
Registry record updated Aug 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
0778DC Issued in OH
Legal business name
RENAL LIFE LINK INC
Practice address
3070 Presidential Dr Ste a
Beavercreek, OH 45324-6273
Phone
(937) 426-6475
Fax
(937) 426-2436
NPI assigned
Apr 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2026

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 0778DC OH Primary

Addresses

Primary practice location

3070 Presidential Dr Ste a
Beavercreek, OH 45324-6273

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
2638908MedicaidOH

Other names 1

  • Fairborn Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050725000749 OH Part A Provider - End-Stage Renal Disease Facility (ESRD) 9931162211 Practice locations: Beavercreek, OH

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Fairborn DialysisCCN 362683
Overall star rating
3.0 of 5
Ownership
Profit
Certified
Jan 19, 2006
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
12

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
36D1043865Fairborn Dialysis3070 Presidential Dr Ste a, Beavercreek, OH 45324Certificate of waiverAug 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Renal Life Link Inc32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786665600000",
    "number": "1689639502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: 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": "3070 PRESIDENTIAL DR STE A",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "453246273",
            "telephone_number": "937-426-6475",
            "fax_number": "937-426-2436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL LIFE LINK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2026-08-14",
        "certification_date": "2026-08-14",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "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": "OH",
            "license": "0778DC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2638908",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairborn Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fairborn Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beavercreek, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2026; 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.