Organization
DVA RENAL HEALTHCARE INC
Active
Other names
DeRidder Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
239 E 1ST ST, DERIDDER, LA 70634-4105
(337) 462-0950
(337) 460-1933
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 341-6764
(833) 781-6999
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
130
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1102075
—
LA
Enumeration date
03/18/2006
Last updated
04/20/2021
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