Provider Demographics
NPI:1447889399
Name:LEGACY DIALYSIS OF VIRGINIA
Entity type:Organization
Organization Name:LEGACY DIALYSIS OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:ANJOS
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-781-7741
Mailing Address - Street 1:50 E SAMPLE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3552
Mailing Address - Country:US
Mailing Address - Phone:954-781-7741
Mailing Address - Fax:888-349-8679
Practice Address - Street 1:211 GIBSON ST NW STE 209
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2115
Practice Address - Country:US
Practice Address - Phone:954-781-7741
Practice Address - Fax:888-349-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment