Organization
CVS-SHC KIDNEY CARE HOME DIALYSIS OF PHILADELPHIA LLC
Active
Other names
CVS Kidney Care Home Dialysis Satellite Healthcare WellBound
Organization subpart
No
Provider details
NPI number
Authorized official
KARI HOLLOWAY (VP)
(404) 290-5964
Entity
Organization
Contact information
Practice address
1945 ROUTE 70 E STE A, CHERRY HILL, NJ 08003-2117
(856) 229-8010
(856) 751-8202
Mailing address
300 SANTANA ROW STE 300, SAN JOSE, CA 95128-2424
(669) 236-5947
(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
—
25196
STATE LICENSE
NJ
Enumeration date
11/02/2020
Last updated
11/02/2020
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