Organization
DVA HEALTHCARE RENAL CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
6304 WOODSIDE CT STE 102, COLUMBIA, MD 21046-3217
(667) 261-6766
(667) 261-6783
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
E2628R
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
035668700
—
DC
05
—
401340900
—
MD
Enumeration date
03/23/2006
Last updated
03/13/2025
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