Provider Demographics
NPI:1316646565
Name:KIDNEY CARE INTEGRATED SERVICES, LLC
Entity type:Organization
Organization Name:KIDNEY CARE INTEGRATED SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY AND CLO
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-236-7061
Mailing Address - Street 1:1861 INTERNATIONAL DR STE 600
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4420
Mailing Address - Country:US
Mailing Address - Phone:571-992-0600
Mailing Address - Fax:
Practice Address - Street 1:1861 INTERNATIONAL DR STE 600
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4420
Practice Address - Country:US
Practice Address - Phone:571-992-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No251B00000XAgenciesCase Management