Provider Demographics
NPI:1831213511
Name:COMMUNITY DIALYSIS LLC
Entity type:Organization
Organization Name:COMMUNITY DIALYSIS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
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:630-690-4642
Mailing Address - Street 1:244 KNOLL ST
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4559
Mailing Address - Country:US
Mailing Address - Phone:630-690-4642
Mailing Address - Fax:
Practice Address - Street 1:16641 HALSTED ST
Practice Address - Street 2:STE A
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-6100
Practice Address - Country:US
Practice Address - Phone:630-690-4642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-12-24
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
IL142698Medicare Oscar/Certification