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Organization

DVA HEALTHCARE RENAL CARE INC

Active
Other names
Coastal Plains
Organization subpart
No

Provider details

NPI number
Authorized official
SAMUEL T WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization

Contact information

Practice address
209 NC HIGHWAY 111 S, GOLDSBORO, NC 27534-9253
(919) 778-5766
(919) 751-7672
Mailing address
5200 VIRGINIA WAY, L & C DEPARTMENT, BRENTWOOD, TN 37027-7569

Taxonomy

Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1639695984
NC
Enumeration date
08/18/2017
Last updated
12/11/2024
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