NPIMap

Organization Active NPI

CVS-SHC Kidney Care Home Dialysis of Los Angeles LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • South Gate, CA
National Provider Identifier
1134740848
Registry record updated May 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
CVS-SHC KIDNEY CARE HOME DIALYSIS OF LOS ANGELES LLC
Practice address
8716 Garfield Ave Ste 100
South Gate, CA 90280-3723
Phone
(562) 674-2600
Fax
(562) 928-9304
NPI assigned
May 4, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kari Holloway
Title
VP
Phone
(404) 290-5964

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

8716 Garfield Ave Ste 100
South Gate, CA 90280-3723

Mailing address

300 Santana Row Ste 300
San Jose, CA 95128-2424
Phone (650) 404-3655

Other identifiers 1

IdentifierTypeStateIssuer
014668OtherCABUSINESS LICENSE

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588550400000",
    "number": "1134740848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SANTANA ROW STE 300",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282424",
            "telephone_number": "650-404-3655",
            "fax_number": "650-625-6007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8716 GARFIELD AVE STE 100",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902803723",
            "telephone_number": "562-674-2600",
            "fax_number": "562-928-9304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CVS-SHC KIDNEY CARE HOME DIALYSIS OF LOS ANGELES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-04",
        "last_updated": "2020-05-04",
        "certification_date": "2020-05-04",
        "status": "A",
        "authorized_official_last_name": "HOLLOWAY",
        "authorized_official_first_name": "KARI",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "404-290-5964"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS LICENSE",
            "identifier": "014668",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Gate, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.