Provider Demographics
NPI:1861435497
Name:DCA OF YORK LLC
Entity type:Organization
Organization Name:DCA OF YORK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-736-2700
Mailing Address - Street 1:PO BOX 19119
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-6601
Mailing Address - Country:US
Mailing Address - Phone:870-931-5400
Mailing Address - Fax:870-931-5418
Practice Address - Street 1:1975 KENNETH RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-9101
Practice Address - Country:US
Practice Address - Phone:717-764-8322
Practice Address - Fax:717-764-4714
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U S RENAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-13
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017786620001Medicaid
PA39-2731Medicare ID - Type Unspecified