Healthcare Provider Details

I. General information

NPI: 1578522314
Provider Name (Legal Business Name): DVA HEALTHCARE RENAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 05/31/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 W CITY DR
ELIZABETH CITY NC
27909-9632
US

IV. Provider business mailing address

5200 VIRGINIA WAY ATT: L&C DEPARTMENT
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-2217
  • Fax: 252-338-4051
Mailing address:
  • Phone: 615-320-4593
  • Fax: 800-293-5872

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 StateNC

VIII. Authorized Official

Name: JOHN D WINSTEL
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 253-733-4501