| Name: | DVA Healthcare Renal Care, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Corporation |
| Status: | Exists |
| Entity Number: | 000-858-189 |
| Register Number: | 000858189 |
| Historical Names: |
Community Dialysis Centers
Vivra Renal Care, Inc. GAMBRO Healthcare Renal Care, Inc. |
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Nevada |
| Principal Address: | 10810 W COLLINS AVELAKEWOOD, CO 80215 |
| Registered Office Street Address: | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013980747 | 2006-02-13 | 2024-05-09 | 5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN, 370277569, US | 195 BUNTING DR, OZARK, AL, 363601101, US | |||||||||||||||||||||||||||||||
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| Phone | +1 334-774-1410 |
| Fax | 3347742690 |
Authorized person
| Name | SAMUEL T WEY |
| Role | VP LICENSURE & CERTIFICATION |
| Phone | 6153416641 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| License Number | S2301 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | DIA2544D |
| State | AL |
| Issuer | MEDICAID |
| Number | 890060400 |
| State | FL |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 607T8 | Active | Non-Manufacturer | 2010-05-19 | 2022-12-19 | 2026-11-23 | 2022-12-19 | |||||||||||||||||||||||
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| POC | DONNA BRAWLEY |
| Phone | +1 253-382-1493 |
| Fax | +1 888-577-9570 |
| Address | 216 GRACELAND DR, DOTHAN, AL, 36305 7346, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | |
|---|---|
| Vendor Certified | 2021-11-23 |
| CAGE number | 45JM2 |
| Company Name | DAVITA INC. |
| CAGE Last Updated | 2024-03-29 |
| List of Offerors (0) | Information not Available |
|---|
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY INC | Agent | 251 LITTLE FALLS DRIVEWILMINGTON, DE 19808 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2005-10-13 | Name Change | GAMBRO Healthcare Renal Care, Inc. | DVA Healthcare Renal Care, Inc. |
| 1997-08-19 | Name Change | Vivra Renal Care, Inc. | GAMBRO Healthcare Renal Care, Inc. |
| 1995-10-18 | Name Change | Community Dialysis Centers | Vivra Renal Care, Inc. |
| 1988-05-06 | Name Merged | No data | NON-QUALIFIED FOREIGN INTO QUALIFIED * Name Not On Data Base |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
