Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Waverly 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
407 BALTIMORE PIKE, MORTON, PA 19070-1042
(610) 690-1100
(610) 690-3618
Mailing address
5200 VIRGINIA WAY, ATT: 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
—
001094934
—
DE
05
—
1007635580129
—
PA
05
—
455514
—
AZ
05
—
8452504
—
NJ
Enumeration date
04/06/2006
Last updated
05/01/2026
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