Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Liberty Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
2525 GLENN HENDREN DR, LIBERTY, MO 64068-9625
(816) 781-4422
(816) 792-2101
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
501537831
—
MO
Enumeration date
03/31/2006
Last updated
06/20/2024
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