NPIMap

Organization Active NPI

Kidney Life, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • West Orange, NJ
National Provider Identifier
1295070811
Registry record updated Mar 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
KIDNEY LIFE, LLC
Practice address
375 Mount Pleasant Ave
Ste 340
West Orange, NJ 07052-2750
Phone
(973) 243-7069
Fax
(973) 731-1348
NPI assigned
Dec 7, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2025

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

Authorized official

Name
Samuel Wey
Title
VP Licensure & Certification
Phone
(615) 341-6641

Specialties & licenses 1

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

Addresses

Primary practice location

375 Mount Pleasant Ave
Ste 340
West Orange, NJ 07052-2750

Mailing address

5200 Virginia Way
L & C Dept
Brentwood, TN 37027-7569

Other identifiers 1

IdentifierTypeStateIssuer
0968676MedicaidNJ

Other names 1

  • West Orange Dialysis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230417000841 NJ Part A Provider - End-Stage Renal Disease Facility (ESRD) 2769665207 Practice locations: West Orange, NJ

Other NPIs with the same Medicare PAC ID 23

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 23

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D2061762West Orange Dialysis375 Mount Pleasant Avenue, West Orange, NJ 07052Certificate of waiverJul 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Kidney Life LLC24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Member of 1

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

Locations

375 Mount Pleasant Ave
Ste 340
West Orange, NJ 07052
Phone (833) 386-2356

NPI Registry JSON

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

{
    "created_epoch": "1354838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741651200000",
    "number": "1295070811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L & C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 MOUNT PLEASANT AVE",
            "address_2": "STE 340",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070522750",
            "telephone_number": "973-243-7069",
            "fax_number": "973-731-1348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-07",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0968676",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Orange Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Orange Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Orange, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.