Healthcare Provider Details

I. General information

NPI: 1629043583
Provider Name (Legal Business Name): DVA HEALTHCARE RENAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N 13TH AVE
UPLAND CA
91786-4957
US

IV. Provider business mailing address

5200 VIRGINIA WAY STE 400
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 909-946-3802
  • Fax: 909-946-0515
Mailing address:
  • Phone: 615-341-6765
  • Fax: 833-782-9089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number240000013
License Number StateCA

VIII. Authorized Official

Name: JAMES K HILGER
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 253-733-4500