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NPI Code Detail

MEDICARE: LOURDES DIALYSIS AT INNOVA, INC.

MEDICARE: LOURDES DIALYSIS AT INNOVA, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/CenterNJ

General Provider Information

NPI Number : 1134373905
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOURDES DIALYSIS AT INNOVA, INC.
Provider Business Mailing Address
First Line : 1600 HADDON AVE
Second Line :
City : CAMDEN
State : NJ
Zip : 08103-3101
Country : US
Telephone Number : 856-757-3500
Fax Number :
Provider Business Practice Location Address
First Line : 3716 CHURCH RD.
Second Line :
City : MT. LAUREL
State : NJ
Zip : 08054-1104
Country : US
Telephone Number : 856-757-3500
Fax Number :
Authorized Official
Title or Position : AVP LEGAL SERVICES
Name : JENNIFER SCHWARTZ
Credential :
Telephone Number : 856-580-6314
Provider Enumeration Date : 11/06/2008
Last Update Date : 11/11/2008

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