Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
South Charlotte 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
10504 PARK RD, CHARLOTTE, NC 28210-8405
(980) 399-4784
(980) 399-4817
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4593
(800) 293-5872
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
—
3412523
—
NC
05
—
NDC002
—
SC
Enumeration date
03/21/2006
Last updated
01/23/2024
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