Healthcare Provider Details

I. General information

NPI: 1588525935
Provider Name (Legal Business Name): DAVITA MEDICAL HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 BATTLEFIELD BLVD N STE 100
CHESAPEAKE VA
23320-0305
US

IV. Provider business mailing address

2000 16TH ST
DENVER CO
80202-5117
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-8346
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL T WEY
Title or Position: VP, LICENSURE & CERTIFICATION
Credential:
Phone: 615-341-6641