Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Deland 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
350 E NEW YORK AVE, DELAND, FL 32724-5510
(386) 738-2570
(386) 738-9576
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
—
200566200
—
FL
Enumeration date
03/03/2006
Last updated
10/07/2024
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