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General NPI Number Information
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NPI Number | 1245831767
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Entity Type | Organization
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Legal Business Name | CVS-SHC KIDNEY CARE HOME DIALYSIS OF PHILADELPHIA LLC
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 1945 ROUTE 70 E STE A
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City | CHERRY HILL
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State | NJ
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Zip | 08003-2117
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Country | US
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Telephone | 856-229-8010
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Fax | 856-751-8202
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Provider Business Mailing Address
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Address Line | 300 SANTANA ROW STE 300
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City | SAN JOSE
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State | CA
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Zip | 95128-2424
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Country | US
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Telephone | 669-236-5947
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Fax | 650-625-6007
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Authorized Official
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Title or Position | VP
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Name | KARI HOLLOWAY
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Credential |
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Telephone | 404-290-5964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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