Provider Demographics
NPI:1033409800
Name:CREIGHTON DIALYSIS LLC
Entity Type:Organization
Organization Name:CREIGHTON DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:CYTLAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-423-5497
Mailing Address - Street 1:1000 E MAIN CROSS ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-6317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 E MAIN CROSS ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-6317
Practice Address - Country:US
Practice Address - Phone:419-423-5184
Practice Address - Fax:419-423-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment