Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Crooked Creek 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
6070 W HIGHWAY 74, INDIAN TRAIL, NC 28079-3591
(980) 446-1305
(980) 446-1388
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
—
3402666
—
NC
Enumeration date
07/11/2008
Last updated
03/12/2025
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