Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Lake Charles Southwest 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
300 18TH ST, LAKE CHARLES, LA 70601-7342
(337) 433-6831
(337) 433-6613
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
060
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1102121
—
LA
Enumeration date
03/18/2006
Last updated
01/27/2026
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