Provider Demographics
NPI:1952965253
Name:DIALYSIS CARE CENTER ELGIN LLC
Entity Type:Organization
Organization Name:DIALYSIS CARE CENTER ELGIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MORUFU
Authorized Official - Middle Name:OLATUNJI
Authorized Official - Last Name:ALAUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-741-6830
Mailing Address - Street 1:PO BOX 3134
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60434-3134
Mailing Address - Country:US
Mailing Address - Phone:815-714-7171
Mailing Address - Fax:815-941-1806
Practice Address - Street 1:995 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2336
Practice Address - Country:US
Practice Address - Phone:224-230-4340
Practice Address - Fax:224-230-4370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment