Organization
CENTRAL LITTLE ROCK DIALYSIS
Active
Organization
CENTRAL LITTLE ROCK DIALYSIS
Active
Other names
DVA Renal Healthcare Inc
Organization subpart
No
Provider details
NPI number
Authorized official
KENT THIRY CHAIRMAN (CEO)
(303) 876-6000
Entity
Organization
Contact information
Practice address
1423 PACIFIC AVE, TACOMA, WA 98402-4203
(253) 382-1752
Mailing address
6 FREEWAY DR, STE 100, LITTLE ROCK, AR 72204-2486
(501) 664-6754
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
04D1004570
AR
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
1376516039
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150329734
—
AR
Enumeration date
04/04/2014
Last updated
04/04/2014
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