Organization
DVA RENAL HEALTHCARE INC
Active
Other names
St Louis West Home Training
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
9632 OLIVE BLVD, OLIVETTE, MO 63132-3002
(314) 569-8902
(314) 995-7071
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
—
505148809
—
MO
Enumeration date
03/31/2006
Last updated
02/12/2025
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