Provider Demographics
NPI:1568824423
Name:PENINSULA CONTINUUM SERVICES LLC
Entity Type:Organization
Organization Name:PENINSULA CONTINUUM SERVICES LLC
Other - Org Name:QUALITY KIDNEY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PASQUALE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBENEDICTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-422-7818
Mailing Address - Street 1:5015 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1110
Mailing Address - Country:US
Mailing Address - Phone:800-975-5201
Mailing Address - Fax:800-975-5201
Practice Address - Street 1:5015 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1110
Practice Address - Country:US
Practice Address - Phone:800-975-5201
Practice Address - Fax:800-975-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7003286R261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
332742OtherCCN