Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Manteca 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
1620 W YOSEMITE AVE, MANTECA, CA 95337-5190
(209) 825-3905
(209) 824-6870
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
110000462
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881668788
—
CA
Enumeration date
02/15/2006
Last updated
02/18/2025
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