MEDICARE: KIDNEY LIFE, LLC

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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	22532	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831458660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDNEY LIFE, LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L & C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 5TH ST
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-1710
Country	:	US
Telephone Number	:	201-770-9220
Fax Number	:	201-770-9225

Authorized Official
Title or Position	:	VP, LICENSURE & CERTIFICATION
Name	:	SAMUEL WEY
Credential	:
Telephone Number	:	615-341-6641

Provider Enumeration Date	:	05/14/2012
Last Update Date	:	03/06/2026

Similar Medicare Providers

1386624054 — JERSEY CITY ARTIFICIAL KIDNEY CENTER, LLC
Practice Location Address:

1310 5TH ST
NORTH BERGEN, NJ
07047-1710

Practice Phone: 201-770-9220
Practice Fax: 201-770-9225

1407844434 — DIGHTON CORPORATION
Practice Location Address:

907 CENTER ST
NORTH DIGHTON, MA
02764-1710

Practice Phone: 508-990-1133
Practice Fax: 508-990-2379

1144256587 — SPEARFISH EYE CARE CENTER
Practice Location Address:

1710 NORTH AVE
SPEARFISH, SD
57783-1218

Practice Phone: 605-642-8430
Practice Fax: 605-642-8185

1134143811 — OZARK SYSTEMS MANUFACTURING, LLC
Practice Location Address:

501 NORTH LINCOLN ST
SILOAM SPRINGS, AR
72761-1710

Practice Phone: 479-524-9778
Practice Fax: 479-524-6913

1477564771 — DR. KATHRYN OPBROEK HAIVALA OD
Practice Location Address:

1710 NORTH AVE
SPEARFISH, SD
57783

Practice Phone: 605-642-8480
Practice Fax: 605-642-8185

1992815500 — DR. MICHAEL S RICHEY OD
Practice Location Address:

1710 NORTH AVE
SPEARFISH, SD
57783

Practice Phone: 605-642-8480
Practice Fax: 605-642-8185

Directions to “KIDNEY LIFE, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.