Active NPI
Dva Healthcare Renal Care Inc
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Hainesport, NJ
National Provider Identifier
1962431650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- License
- 22348
- Legal business name
- DVA HEALTHCARE RENAL CARE INC
- Practice address
- 1261 Route 38
Ste B
Hainesport, NJ 08036-2702 - Phone
- (609) 914-4420
- Fax
- (609) 845-3099
- NPI assigned
- Jul 3, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Samuel Wey
- Title
- VP, Licensure & Certification
- Phone
- (615) 341-6641
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | 22348 | NJ | Primary |
Addresses
Primary practice location
1261 Route 38
Ste B
Hainesport, NJ 08036-2702
Mailing address
5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6845801 | Medicaid | NJ |
Other names 1
- Lumberton Dialysis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030508000007 | NJ | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 7517875545 | Practice locations: Hainesport, NJ |
Care Compare: Dialysis facility
Medicare Care Compare- Listed as
- DaVita Lumberton Dialysis
- Overall star rating
- Ownership
- Profit
- Certified
- Jul 1, 1997
- Medicare certification status
- Active
- Chain
- DaVita
- Dialysis stations
- 20
Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 31D0694028 | Lumberton Dialysis | Certificate of waiver | Dec 1, 2026 |
National Provider Directory
National Provider Directory- Tax ID family
- CDS of Zephyrhills
Organizations with this tax ID in the same state 2
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Burlington, NJ
- NPI 1508895632
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Delran, NJ
- NPI 1841229663
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Pageland, SC
- NPI 1548222615
Member Of
Locations
1261 Route 38
#B
Hainesport, NJ 08036
Phone (609) 914-4420
Practitioners & affiliated clinicians
Affiliated clinicians 9
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1728432000000",
"number": "1962431650",
"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": "1261 ROUTE 38",
"address_2": "STE B",
"city": "HAINESPORT",
"state": "NJ",
"postal_code": "080362702",
"telephone_number": "609-914-4420",
"fax_number": "609-845-3099"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DVA HEALTHCARE RENAL CARE INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-03",
"last_updated": "2024-10-09",
"certification_date": "2024-10-09",
"status": "A",
"authorized_official_last_name": "WEY",
"authorized_official_first_name": "SAMUEL",
"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": "NJ",
"license": "22348",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6845801",
"state": "NJ"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Lumberton Dialysis",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Lumberton Dialysis",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Hainesport, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 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.