NPIMap

Organization Active NPI

Renal Life Link Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Leitchfield, KY
National Provider Identifier
1790740652
Registry record updated Aug 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
300171 Issued in KY
Legal business name
RENAL LIFE LINK INC
Practice address
912 Wallace Ave
Ste 106
Leitchfield, KY 42754-2405
Phone
(270) 230-0163
Fax
(270) 230-0173
NPI assigned
Apr 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2024

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 300171 KY Primary

Addresses

Primary practice location

912 Wallace Ave
Ste 106
Leitchfield, KY 42754-2405

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
39000807MedicaidKY

Other names 1

  • Leitchfield Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050311000231 KY Part A Provider - End-Stage Renal Disease Facility (ESRD) 9931162211 Practice locations: Leitchfield, KY

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Leitchfield DialysisCCN 182574
Overall star rating
3.0 of 5
Ownership
Profit
Certified
May 25, 2005
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
10

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
18D1038914Leitchfield Dialysis912 Wallace Avenue, Suite 106, Leitchfield, KY 42754Certificate of waiverMar 29, 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

Locations

912 Wallace Ave
Ste 106
Leitchfield, KY 42754
Phone (270) 230-0153

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": "1723680000000",
    "number": "1790740652",
    "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": "912 WALLACE AVE",
            "address_2": "STE 106",
            "city": "LEITCHFIELD",
            "state": "KY",
            "postal_code": "427542405",
            "telephone_number": "270-230-0163",
            "fax_number": "270-230-0173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL LIFE LINK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "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": "KY",
            "license": "300171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39000807",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Leitchfield Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Leitchfield Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leitchfield, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; 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.