Healthcare Provider Details

I. General information

NPI: 1528313285
Provider Name (Legal Business Name): KIDNEY HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BECKS WOODS DR SUITE 102
BEAR DE
19701-3854
US

IV. Provider business mailing address

2006 LIMESTONE RD SUITE 7
WILMINGTON DE
19808-5553
US

V. Phone/Fax

Practice location:
  • Phone: 302-355-2383
  • Fax:
Mailing address:
  • Phone: 302-355-2383
  • Fax: 302-351-6261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number StateDE

VIII. Authorized Official

Name: MANISH GARG
Title or Position: PRESIDENT
Credential:
Phone: 302-355-2383