Healthcare Provider Details

I. General information

NPI: 1013981851
Provider Name (Legal Business Name): DVA RENAL HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11374 PLEASANT VALLEY RD
PENN VALLEY CA
95946-9000
US

IV. Provider business mailing address

5200 VIRGINIA WAY STE 400
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 530-432-2274
  • Fax: 530-432-3194
Mailing address:
  • Phone: 614-320-4435
  • Fax: 303-209-7821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: THOMAS O USILTON JR.
Title or Position: GROUP VICE PRESIDENT
Credential:
Phone: 770-541-7922