Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Benicia 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
560 1ST ST, STE D103, BENICIA, CA 94510-3293
(707) 745-1488
(707) 745-8089
Mailing address
5200 VIRGINIA WAY, L&C DEPARTMENT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
110000442
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1427022797
—
CA
Enumeration date
02/14/2006
Last updated
01/21/2025
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