| Name: | DVA Renal Healthcare, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Corporation |
| Status: | Exists |
| Date of registration: | 20 Jul 1987 (37 years ago) (Companies founded in July 1987) |
| Entity Number: | 000-916-540 |
| Register Number: | 000916540 |
| Historical Names: |
Gambro Healthcare, Inc.
|
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Tennessee |
| Principal Address: | 5200 VIRGINIA WAYBRENTWOOD, TN 37027 |
| Principal Mailing Address: | 1450 ENERGY PARK DRIVE SUITE 300ST PAUL, MN 55108 |
| Registered Office Street Address: | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629415609 | 2013-05-30 | 2023-12-07 | 5200 VIRGINIA WAY, L & C DEPT, BRENTWOOD, TN, 370277569, US | 300 B 22ND ST SOUTH, BIRMINGHAM, AL, 352332209, US | |||||||||||||||||||||||||||||
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| Phone | +1 615-320-4268 |
| Fax | 8772380567 |
| Phone | +1 205-250-6757 |
| Fax | 2054580146 |
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 | S3734 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 156375 |
| State | AL |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 5ZFY7 | Active | Non-Manufacturer | 2010-04-28 | 2022-12-30 | 2026-12-02 | 2022-12-30 | |||||||||||||||||||||||
|
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| POC | DONNA BRAWLEY |
| Phone | +1 253-382-1493 |
| Fax | +1 888-577-9570 |
| Address | 422 E DR HICKS BLVD STE B, FLORENCE, AL, 35630 5730, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | |
|---|---|
| Vendor Certified | 2021-12-02 |
| 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 |
|---|---|---|---|
| 2005-11-28 | Name Change | Gambro Healthcare, Inc. | DVA Renal Healthcare, Inc. |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
