Provider Demographics
NPI:1396907267
Name:AFFILIATED HOME DIALYSIS LLC
Entity type:Organization
Organization Name:AFFILIATED HOME DIALYSIS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CURT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANLIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-942-1111
Mailing Address - Street 1:2462 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-1756
Mailing Address - Country:US
Mailing Address - Phone:309-698-1800
Mailing Address - Fax:309-698-1811
Practice Address - Street 1:1014 BONAVENTURE DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3277
Practice Address - Country:US
Practice Address - Phone:309-698-1811
Practice Address - Fax:309-698-1811
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFILIATED HOME DIALYSIS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-01
Last Update Date:2016-07-11
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
IL142699Medicare Oscar/Certification