Provider Demographics
NPI:1013593144
Name:FRESENIUS MEDICAL CARE LINCOLNWOOD DIALYSIS, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE LINCOLNWOOD DIALYSIS, LLC
Other - Org Name:FRESENIUS KIDNEY CARE LINCOLNWOOD DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-632-3415
Mailing Address - Street 1:7301 N LINCOLN AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1735
Mailing Address - Country:US
Mailing Address - Phone:847-675-5555
Mailing Address - Fax:
Practice Address - Street 1:7301 N LINCOLN AVE STE 205
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1735
Practice Address - Country:US
Practice Address - Phone:847-675-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-19
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment