Provider Demographics
NPI:1376199190
Name:DIALYSIS CARE CENTER HAZEL CREST LLC
Entity Type:Organization
Organization Name:DIALYSIS CARE CENTER HAZEL CREST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MORUFU
Authorized Official - Middle Name:OLATUNJI
Authorized Official - Last Name:ALAUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-741-6830
Mailing Address - Street 1:PO BOX 3134
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60434-3134
Mailing Address - Country:US
Mailing Address - Phone:815-714-7171
Mailing Address - Fax:
Practice Address - Street 1:18325 PULASKI AVE UNIT A-B
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2480
Practice Address - Country:US
Practice Address - Phone:708-824-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment