Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Airport Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES K HILGER (CHIEF ACCOUNTING OFFICER)
(253) 280-9501
Entity
Organization
Contact information
Practice address
4632 W CENTURY BLVD, INGLEWOOD, CA 90304-1456
(310) 677-4262
(310) 677-1034
Mailing address
5200 VIRGINIA WAY, L&C 4TH FL, BRENTWOOD, TN 37027-7569
(615) 341-5895
(866) 890-5560
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
930000862
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588638191
—
CA
Enumeration date
02/13/2006
Last updated
01/03/2013
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