Organization
DVA HEALTHCARE RENAL CARE INC
Active
Organization
DVA HEALTHCARE RENAL CARE INC
Active
Other names
Hinesville Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
522 ELMA G MILES PKWY, HINESVILLE, GA 31313-4021
(912) 368-4850
(912) 368-7247
Mailing address
5200 VIRGINIA WAY, L&C DEPT., BRENTWOOD, TN 37027-7569
(615) 320-4268
(877) 238-0567
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
ESRD001148
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000411386A
—
GA
01
—
11D0687785
CLIA WAIVER
GA
Enumeration date
03/14/2006
Last updated
01/12/2021
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