Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Mint Hill Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (SR DIRECTOR,LICENSURE&CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
11308 HAWTHORNE DR, MINT HILL, NC 28227-9300
(704) 573-2549
(704) 545-3747
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4593
(800) 293-5872
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
—
1205116167
—
NC
Enumeration date
08/24/2011
Last updated
08/10/2023
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