HOME DIALYSIS SERVICES PEORIA LLC NPI 1275922890

NPI Information

NPI: 1275922890
Provider Name: HOME DIALYSIS SERVICES PEORIA LLC
Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 14D2108022

Address:
719 MAIN ST STE B
PEORIA, IL
ZIP 61602
Phone: (309) 966-0802
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HOME DIALYSIS SERVICES PEORIA LLC is an end-stage renal disease (esrd) treatment clinic center in Peoria, IL. HOME DIALYSIS SERVICES PEORIA LLC NPI is 1275922890. The provider is registered as an organization entity type.

The provider's business location address is:

719 MAIN ST STE B
PEORIA, IL
ZIP 61602-084
Phone: (309) 966-0802
Fax: (309) 713-2633

The provider's authorized official is Morufu Alausa .
The authorized official title is Medical Director/ceo and has the following contact phone number (815) 741-6830.

The CLIA number assigned to this NPI record is 14D2108022 - end stage renal disease dialysis with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/20/2015 and was last updated on 10/1/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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