Provider Demographics
NPI:1114300266
Name:AFFILIATED DIALYSIS OF OHIO LLC
Entity Type:Organization
Organization Name:AFFILIATED DIALYSIS OF OHIO LLC
Other - Org Name:AFFILIATED DIALYSIS OF OHIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CURT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANLIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-942-1111
Mailing Address - Street 1:800 ROOSEVELT RD
Mailing Address - Street 2:STE E-320
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5839
Mailing Address - Country:US
Mailing Address - Phone:630-942-1111
Mailing Address - Fax:630-942-1112
Practice Address - Street 1:3619 PARK EAST DR
Practice Address - Street 2:STE 110-SOUTH
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4330
Practice Address - Country:US
Practice Address - Phone:216-896-0639
Practice Address - Fax:216-896-0663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2016-10-19
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
OH362842Medicare Oscar/Certification