Organization
DVA HEALTHCARE RENAL CARE, INC.
Active
Other names
Lakeland Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
515 E BELLA VISTA ST, LAKELAND, FL 33805-3005
(863) 688-5463
(863) 688-7150
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200519100
—
FL
Enumeration date
03/07/2006
Last updated
08/27/2024
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