Provider Demographics
NPI:1770632960
Name:X-CHANGE DIALYSIS, INC.
Entity Type:Organization
Organization Name:X-CHANGE DIALYSIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:JAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-382-5911
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:FOX RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60021-0057
Mailing Address - Country:US
Mailing Address - Phone:847-382-5911
Mailing Address - Fax:847-381-4704
Practice Address - Street 1:525 W OLD NORTHWEST HWY
Practice Address - Street 2:SUITE 202C
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6814
Practice Address - Country:US
Practice Address - Phone:847-382-5911
Practice Address - Fax:847-381-4704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332BD1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4683430001Medicare NSC