Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Greater Waterbury Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
209 HIGHLAND AVE, WATERBURY, CT 06708
(203) 574-7933
(203) 574-4136
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
0250
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004161303
—
CT
01
—
0250
STATE LICENSE
CT
Enumeration date
02/23/2006
Last updated
12/20/2024
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