Active NPI
CVS-SHC Kidney Care Home Dialysis of Philadelphia LLC
Doing business as CVS Kidney Care-Satellite Healthcare Ridley
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Folsom, PA
National Provider Identifier
1699417824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Legal business name
- CVS-SHC KIDNEY CARE HOME DIALYSIS OF PHILADELPHIA LLC
- Doing business as
- CVS Kidney Care-Satellite Healthcare Ridley
- Practice address
- 1939 Macdade Boulevard
Folsom, PA 19033-1214 - Phone
- (610) 616-5555
- Fax
- (610) 461-3424
- NPI assigned
- Apr 8, 2022
- Last updated
- Apr 8, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Bernadette Vincent
- Title
- President/Coo
- Phone
- (669) 266-6359
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | NU | Primary |
Addresses
Primary practice location
1939 Macdade Boulevard
Folsom, PA 19033-1214
Mailing address
300 Santana Row Ste 300
San Jose, CA 95128-2424
Phone (669) 236-5947
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03312022 | Other | PA | ASSUMED NAME |
Other names 1
- CVS Kidney Care-Satellite Healthcare Ridley
National Provider Directory
National Provider Directory- Tax ID family
- CVS Kidney Care Home Dialysis Satellite Healthcare Wellbound
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba CVS Kidney Care Home Dialysis Satellite Healthcare WellBound
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Cherry Hill, NJ
- NPI 1245831767
Locations
1939 Macdade Blvd
Folsom, PA 19033
Phone (610) 616-5555
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649376000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1649376000000",
"number": "1699417824",
"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": "669-236-5947",
"fax_number": "650-625-6007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1939 MACDADE BOULEVARD",
"city": "FOLSOM",
"state": "PA",
"postal_code": "190331214",
"telephone_number": "610-616-5555",
"fax_number": "610-461-3424"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CVS-SHC KIDNEY CARE HOME DIALYSIS OF PHILADELPHIA LLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-04-08",
"last_updated": "2022-04-08",
"certification_date": "2022-03-31",
"status": "A",
"authorized_official_last_name": "VINCENT",
"authorized_official_first_name": "BERNADETTE",
"authorized_official_title_or_position": "PRESIDENT/COO",
"authorized_official_telephone_number": "669-266-6359"
},
"taxonomies": [
{
"code": "261QE0700X",
"taxonomy_group": "",
"desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASSUMED NAME",
"identifier": "03312022",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "CVS Kidney Care-Satellite Healthcare Ridley",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Folsom, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.