DVA HEALTHCARE RENAL CARE INC NPI 1679547087

NPI Information

NPI: 1679547087
Provider Name: DVA HEALTHCARE RENAL CARE INC

Doing Business As: CHINO DIALYSIS

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
4445 RIVERSIDE DR
CHINO, CA
ZIP 91710
Phone: (909) 464-0347
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DVA HEALTHCARE RENAL CARE INC is an end-stage renal disease (esrd) treatment clinic center in Chino, CA. DVA HEALTHCARE RENAL CARE INC NPI is 1679547087. The provider is registered as an organization entity type.
The provider Is Doing Business As Chino Dialysis.

The provider's business location address is:

4445 RIVERSIDE DR
CHINO, CA
ZIP 91710-961
Phone: (909) 464-0347
Fax: (909) 464-0936

The provider's authorized official is Sam T Wey .
The authorized official title is Vp, Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 05D0963244 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/14/2006 and was last updated on 12/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment	240000523	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1679547087	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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