Basic Information
| Provider Information | |||||||||
| NPI: | 1871889758 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AA HEALTHCARE DIALYSIS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8320 SKOKIE BLVD | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600772545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479834860 | ||||||||
| FaxNumber: | 8476733379 | ||||||||
| Practice Location | |||||||||
| Address1: | 8320 SKOKIE BLVD | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600772545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479834860 | ||||||||
| FaxNumber: | 8476733379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2011 | ||||||||
| LastUpdateDate: | 10/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | TOPPER | ||||||||
| AuthorizedOfficialFirstName: | AARON | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8479834860 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.