Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Ashtabula 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
1614 W 19TH ST, ASHTABULA, OH 44004-3036
(440) 964-9777
(440) 964-8914
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 238-3051
(800) 246-8346
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
0440DC
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0321379
—
OH
05
—
1007635580123
—
PA
Enumeration date
04/13/2006
Last updated
12/12/2023
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