NPIMap

Organization Active NPI

Dva Renal Healthcare Inc

Doing business as Reliant Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Houston, TX
National Provider Identifier
1235193905
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
007308 Issued in TX
Legal business name
DVA RENAL HEALTHCARE INC
Doing business as
Reliant Dialysis
Practice address
1335 La Concha LN
Houston, TX 77054-1809
Phone
(713) 794-0600
Fax
(713) 794-0999
NPI assigned
Apr 12, 2006
Last updated
Mar 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Winstel Jr.
Title
Chief Accounting Officer
Phone
(253) 733-4501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 007308 TX Primary

Addresses

Primary practice location

1335 La Concha LN
Houston, TX 77054-1809

Mailing address

5200 Virginia Way
L&C Department
Brentwood, TN 37027-7569
Phone (615) 341-6764

Other identifiers 1

IdentifierTypeStateIssuer
094292201MedicaidTX

Other names 1

  • Reliant Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235193905. Details of each certification follow.

  • CCN 452705 End-stage renal disease facility · Active · Name & address match · Details

End-stage renal disease facility certification: CCN 452705

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Reliant Dialysis
Certification status
Active
Provider type (POS)
End-stage renal disease facility
Participating since
Mar 31, 1995
Last certification
Mar 28, 2019
Ownership / control type
For Profit
Multi-facility organization
DAVITA INC
Facility address
1335 La Concha
Houston, TX 77054

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615420800000",
    "number": "1235193905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPARTMENT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-341-6764",
            "fax_number": "833-781-6999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1335 LA CONCHA LN",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770541809",
            "telephone_number": "713-794-0600",
            "fax_number": "713-794-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA RENAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-12",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A",
        "authorized_official_last_name": "WINSTEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "253-733-4501",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "TX",
            "license": "007308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "094292201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reliant Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Reliant Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.