Organization
DVA RENAL HEALTHCARE, INC
Active
Other names
Dodge County 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
1949 E 23RD AVE S, FREMONT, NE 68025-2452
(402) 721-7005
(402) 721-7480
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
ESRD004
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0546689
—
IA
Enumeration date
04/03/2006
Last updated
03/10/2025
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