Organization
DVA RENAL HEALTHCARE INC
Active
Other names
Goldsboro South 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
1704 WAYNE MEMORIAL DR, GOLDSBORO, NC 27534-2240
(919) 739-6505
(919) 739-6506
Mailing address
5200 VIRGINIA WAY, 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
—
3412587
—
NC
Enumeration date
03/24/2006
Last updated
01/30/2024
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