{"npi":"1013433713","type":"NPI-2","status":"active","name":{"display":"Havanna Dialysis LLC","other":[],"organization_name":"HAVANNA DIALYSIS LLC","authorised_official":"Samuel Wey"},"specialty":{"primary_taxonomy":"261QE0700X","primary_taxonomy_description":"End-Stage Renal Disease (ESRD) Treatment Clinic/Center","slug":"end-stage-renal-disease-esrd-treatment-clinic-center","schema_org_specialty":null,"all":[{"code":"261QE0700X","description":"End-Stage Renal Disease (ESRD) Treatment Clinic/Center","primary":true,"state":"MD","license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"202 PERRY PKWY STE 3","city":"GAITHERSBURG","state":"MD","postal_code":"208772172","country_code":"US","phone":"3019870912","fax":"3019476115"},{"purpose":"MAILING","street_1":"5200 VIRGINIA WAY","city":"BRENTWOOD","state":"TN","postal_code":"370277569","country_code":"US","street_2":"L&C DEPARTMENT"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"6600131","state":"MD","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20170905000840","type_code":"00-03","type_desc":"PART A PROVIDER - END-STAGE RENAL DISEASE FACILITY (ESRD)","state":"MD","pac_id":"2860765310"}]},"enumeration_date":"2017-08-15","last_updated":"2025-11-17","_meta":{"source":"NPPES","snapshot_date":"2025-11-17","doc_url":"https://findmynpi.com/api"}}