Organization
DVA HEALTHCARE RENAL CARE INC
Active
Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Allendale County Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1241 BOUNDARY ST W, FAIRFAX, SC 29827-3611
(803) 632-1587
(803) 632-1611
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ERD-0059
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000855709M
—
GA
05
—
425570
—
SC
Enumeration date
04/04/2006
Last updated
05/18/2026
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