Organization
DVA HEALTHCARE RENAL CARE, INC.
Active
Other names
Harbor Park Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
111 CHERRY HILL RD, BALTIMORE, MD 21225-1392
(410) 354-3037
(410) 354-3095
Mailing address
5200 VIRGINIA WAY, L&C DEPARTMENT, BRENTWOOD, TN 37027-7569
(615) 320-4214
(866) 944-3352
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
E2556
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007635580125
—
PA
05
—
791600100
—
MD
Enumeration date
03/24/2006
Last updated
02/02/2022
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