Organization
DVA HEALTHCARE RENAL CARE, INC.
Active
Other names
Lake Worth 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
2459 S CONGRESS AVE, STE 100, PALM SPRINGS, FL 33406-7616
(561) 439-1532
(561) 439-1018
Mailing address
5200 VIRGINIA WAY, ATT: 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
—
200518226
—
FL
Enumeration date
03/03/2006
Last updated
12/06/2024
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