Organization
DVA HEALTHCARE OF MASSACHUSETTS, INC
Active
Other names
Plymouth Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS O USILTION JR. (GRAOUP VICE PRESIDENT)
(770) 541-7922
Entity
Organization
Contact information
Practice address
45 RESNICK RD, PLYMOUTH, MA 02360-4844
(508) 747-5444
(508) 747-5331
Mailing address
5200 VIRGINIA WAY, SUITE 400 L&C, BRENTWOOD, TN 37027-7569
(615) 320-4218
(303) 209-7825
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
EA1A
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1311352
—
MA
Enumeration date
03/20/2006
Last updated
08/22/2020
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