Organization Name: | KIDNEY CARE CENTER SOUTH |
NPI Number: | 1144697020 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TUNJI MORUFU ALAUSA (OWNER) |
Mailing Address: | 10508 S Roberts Rd Palos Hills |
State: | IL US |
Postal Code: | 604651934 |
Phone Number: | 7086088122 |
Fax Number: | 7088275419 |
NPI Enumeration Date: | 08/27/2015 |
NPI Last Update Date: | 11/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |