Organization
CVS-SHC KIDNEY CARE HOME DIALYSIS OF LOS ANGELES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARI HOLLOWAY (VP)
(404) 290-5964
Entity
Organization
Contact information
Practice address
8716 GARFIELD AVE STE 100, SOUTH GATE, CA 90280-3723
(562) 674-2600
(562) 928-9304
Mailing address
300 SANTANA ROW STE 300, SAN JOSE, CA 95128-2424
(650) 404-3655
(650) 625-6007
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014668
BUSINESS LICENSE
CA
Enumeration date
05/04/2020
Last updated
05/04/2020
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