Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Grand Central Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
800 GRAND CENTRAL MALL, STE 8, VIENNA, WV 26105-4100
(304) 917-4124
(304) 917-4136
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
—
0402016000
—
WV
05
—
2330025
—
OH
Enumeration date
04/18/2006
Last updated
05/15/2024
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