Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Sorensen Park 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
6212 N 73RD PLZ, STE 100, OMAHA, NE 68134-1801
(402) 571-4147
(402) 573-9208
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0546697
—
IA
Enumeration date
04/03/2006
Last updated
04/24/2024
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