Provider Demographics
NPI:1518409465
Name:STAR DIALYSIS LLC
Entity Type:Organization
Organization Name:STAR DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AAKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-488-1530
Mailing Address - Street 1:4145 LAKE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-5321
Mailing Address - Country:US
Mailing Address - Phone:262-488-1530
Mailing Address - Fax:
Practice Address - Street 1:4145 LAKE MEADOW DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-5321
Practice Address - Country:US
Practice Address - Phone:262-488-1530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities