Basic Information
Provider Information
NPI: 1033409800
EntityType: 2
ReplacementNPI:  
OrganizationName: CREIGHTON DIALYSIS LLC
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Mailing Information
Address1: 1000 E MAIN CROSS ST
Address2: SUITE 102
City: FINDLAY
State: OH
PostalCode: 458406317
CountryCode: US
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Practice Location
Address1: 1000 E MAIN CROSS ST
Address2: SUITE 102
City: FINDLAY
State: OH
PostalCode: 458406317
CountryCode: US
TelephoneNumber: 4194235184
FaxNumber: 4194235519
Other Information
ProviderEnumerationDate: 04/14/2011
LastUpdateDate: 06/22/2011
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AuthorizedOfficialLastName: CYTLAK
AuthorizedOfficialFirstName: DAVE
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AuthorizedOfficialTitleorPosition: CFO
AuthorizedOfficialTelephone: 4194235497
IsSoleProprietor:  
IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QE0700X  Y Ambulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment

No ID Information.


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