Provider Demographics
NPI:1740397660
Name:FRESENIUS MEDICAL CARE OF ILLINOIS, LLC
Entity Type:Organization
Organization Name:FRESENIUS MEDICAL CARE OF ILLINOIS, LLC
Other - Org Name:FRESENIUS MEDICAL CARE DUPAGE HOME DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIVITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-699-9000
Mailing Address - Street 1:501 W LAKE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1419
Mailing Address - Country:US
Mailing Address - Phone:630-758-2490
Mailing Address - Fax:630-758-2491
Practice Address - Street 1:501 W LAKE ST STE 201
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-1419
Practice Address - Country:US
Practice Address - Phone:630-758-2490
Practice Address - Fax:630-758-2491
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESENIUS MEDICAL CARE HOLDINGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-24
Last Update Date:2020-12-23
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
IL03604233901Medicaid
IL142606Medicare Oscar/Certification