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General NPI Number Information
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NPI Number | 1528313285
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Entity Type | Organization
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Legal Business Name | KIDNEY HOME, LLC
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 101 BECKS WOODS DR SUITE 102
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City | BEAR
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State | DE
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Zip | 19701-3854
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Country | US
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Telephone | 302-355-2383
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Fax |
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Provider Business Mailing Address
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Address Line | 2006 LIMESTONE RD SUITE 7
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City | WILMINGTON
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State | DE
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Zip | 19808-5553
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Country | US
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Telephone | 302-355-2383
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Fax | 302-351-6261
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Authorized Official
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Title or Position | PRESIDENT
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Name | MANISH GARG
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Credential |
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Telephone | 302-355-2383
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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 | DE
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