Organization
DVA RENAL HEALTHCARE, INC
Active
Other names
Mt. Auburn Home Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS O USILTON JR. (GROUP VICE PRESIDENT)
(770) 541-7922
Entity
Organization
Contact information
Practice address
2109 READING RD, CINCINNATI, OH 45202-1417
(513) 381-6480
(513) 381-6489
Mailing address
5200 VIRGINIA WAY, STE 400 L&C, BRENTWOOD, TN 37027-7569
(615) 320-4435
(303) 209-7821
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
0576DC
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2220288
—
OH
05
—
3900040100
—
KY
Enumeration date
04/14/2006
Last updated
08/22/2020
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