NPIMap

Organization Active NPI

Kidney Life, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hazlet, NJ
National Provider Identifier
1700815487
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
License
41302 Issued in NJ
Legal business name
KIDNEY LIFE, LLC
Practice address
3053 State Route 35
Hazlet, NJ 07730-1526
Phone
(732) 203-0321
Fax
(732) 203-0279
NPI assigned
Jul 3, 2006
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) 320-4414

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 41302 NJ Primary

Addresses

Primary practice location

3053 State Route 35
Hazlet, NJ 07730-1526

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 341-6410

Other identifiers 1

IdentifierTypeStateIssuer
0983411MedicaidNJ

Other names 1

  • Holmdel Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230417001860 NJ Part A Provider - End-Stage Renal Disease Facility (ESRD) 2769665207 Practice locations: Hazlet, 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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
DaVita Holmdel DialysisCCN 312510
Overall star rating
4.0 of 5
Ownership
Profit
Certified
Jul 1, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Chain
DaVita
Dialysis stations
18

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

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
31D0652984Holmdel Dialysis3053 State Route 35, Hazlet, NJ 07730Certificate of waiverAug 31, 2026

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 3

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

Locations

3053 State Route 35
Ste 201
Hazlet, NJ 07730

Practitioners & affiliated clinicians

Affiliated clinicians 7

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741651200000",
    "number": "1700815487",
    "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",
            "telephone_number": "615-341-6410",
            "fax_number": "888-662-8259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3053 STATE ROUTE 35",
            "city": "HAZLET",
            "state": "NJ",
            "postal_code": "077301526",
            "telephone_number": "732-203-0321",
            "fax_number": "732-203-0279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "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": "615-320-4414"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NJ",
            "license": "41302",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0983411",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holmdel Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Holmdel Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hazlet, 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.