DVA RENAL HEALTHCARE INC NPI 1689640997

NPI Information

NPI: 1689640997
Provider Name: DVA RENAL HEALTHCARE INC

Doing Business As: NEW HAVEN DIALYSIS

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

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
15 CENTER ST
STE 201
NEW HAVEN, CT
ZIP 06510
Phone: (203) 859-7770
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DVA RENAL HEALTHCARE INC is an end-stage renal disease (esrd) treatment clinic center in New Haven, CT. DVA RENAL HEALTHCARE INC NPI is 1689640997. The provider is registered as an organization entity type.
The provider Is Doing Business As New Haven Dialysis.

The provider's business location address is:

15 CENTER ST
STE 201
NEW HAVEN, CT
ZIP 06510-003
Phone: (203) 859-7770
Fax: (203) 495-1454

The provider's authorized official is Samuel 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 07D0877834 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/27/2006 and was last updated on 4/1/2024.

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	0267	CONNECTICUT	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	004199619	MEDICAID	CONNECTICUT

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: 4/28/2024

NPI Synchronization or Removal

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