| Organization Name: | DVA HEALTHCARE RENAL CARE INC |
| NPI Number: | 1013984533 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JIM K HILGER (CHIEF ACCOUNTING OFFICER) |
| Mailing Address: | 1801 S Nova Rd Suite 306 South Daytona |
| State: | FL US |
| Postal Code: | 321191775 |
| Phone Number: | 3863223625 |
| Fax Number: | 3863223695 |
| NPI Enumeration Date: | 03/02/2006 |
| NPI Last Update Date: | 10/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |