Healthcare Provider Details

I. General information

NPI: 1194799544
Provider Name (Legal Business Name): DVA HEALTHCARE RENAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 DOVER PKWY
DELANO CA
93215-3714
US

IV. Provider business mailing address

5200 VIRGINIA WAY L&C DEPT
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 661-725-1370
  • Fax: 661-725-1323
Mailing address:
  • Phone: 615-238-3085
  • Fax: 800-268-9682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number240000778
License Number StateCA

VIII. Authorized Official

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