NPIMap

Organization Active NPI

Dva Healthcare Renal Care Inc

Doing business as Hanford Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hanford, CA
National Provider Identifier
1528032505
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
240000784 Issued in CA
Legal business name
DVA HEALTHCARE RENAL CARE INC
Doing business as
Hanford Dialysis
Practice address
402 W 8TH St
Hanford, CA 93230-4536
Phone
(559) 582-5462
Fax
(559) 582-2329
NPI assigned
Feb 15, 2006
Last updated
Jul 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Authorized official

Name
Samuel T. Wey
Title
VP, Licensure & Certification
Phone
(615) 341-6641

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 240000784 CA Primary

Addresses

Primary practice location

402 W 8TH St
Hanford, CA 93230-4536

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
1528032505MedicaidCA

Other names 1

  • Hanford Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030501000000 CA Part A Provider - End-Stage Renal Disease Facility (ESRD) 7517875545 Practice locations: Hanford, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0947606Hanford Dialysis402 W. 8TH Street, Hanford, CA 93230Certificate of waiverJun 18, 2028

National Provider Directory

National Provider Directory
Tax ID family
Community Dialysis Services194 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

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": "1139961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1528032505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 W 8TH ST",
            "city": "HANFORD",
            "state": "CA",
            "postal_code": "932304536",
            "telephone_number": "559-582-5462",
            "fax_number": "559-582-2329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DVA HEALTHCARE RENAL CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-15",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "VP, LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "CA",
            "license": "240000784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528032505",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hanford Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hanford Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hanford, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.