Provider Demographics
NPI:1972624070
Name:HOLY NAME HOME DIALYSIS CENTER, INC.
Entity Type:Organization
Organization Name:HOLY NAME HOME DIALYSIS CENTER, INC.
Other - Org Name:HOLY NAME DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGOLOSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-833-3223
Mailing Address - Street 1:222 CEDAR LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4314
Mailing Address - Country:US
Mailing Address - Phone:201-692-1379
Mailing Address - Fax:201-692-7776
Practice Address - Street 1:222 CEDAR LN
Practice Address - Street 2:SUITE 103
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4314
Practice Address - Country:US
Practice Address - Phone:201-692-1379
Practice Address - Fax:201-692-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6542409Medicaid
NJ6542409Medicaid