Provider Demographics
NPI:1669853206
Name:NOCTURNAL DIALYSIS SPA LLC
Entity Type:Organization
Organization Name:NOCTURNAL DIALYSIS SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREEM
Authorized Official - Middle Name:
Authorized Official - Last Name:SYED SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-748-9407
Mailing Address - Street 1:1634 S ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3742
Mailing Address - Country:US
Mailing Address - Phone:630-620-1233
Mailing Address - Fax:
Practice Address - Street 1:1634 S ARDMORE AVE
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-3742
Practice Address - Country:US
Practice Address - Phone:630-620-1233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment