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RENAL TREATMENT CENTERS ILLINOIS INC NPI 1285694729


NPI Information

NPI: 1285694729
Provider Name: RENAL TREATMENT CENTERS ILLINOIS INC

Doing Business As: CHURCHVIEW DIALYSIS

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 14D1021603

Address:
417 WARE AVE
ROCKFORD, IL
ZIP 61107
Phone: (815) 397-4123
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RENAL TREATMENT CENTERS ILLINOIS INC is an end-stage renal disease (esrd) treatment clinic center in Rockford, IL. RENAL TREATMENT CENTERS ILLINOIS INC NPI is 1285694729. The provider is registered as an organization entity type.
The provider Is Doing Business As Churchview Dialysis.

The provider's business location address is:

417 WARE AVE
ROCKFORD, IL
ZIP 61107-413
Phone: (815) 397-4123
Fax: (815) 397-3059

The provider's authorized official is John D Winstel .
The authorized official title is Chief Accounting Officer and has the following contact phone number (253) 733-4501.

The CLIA number assigned to this NPI record is 14D1021603 - end stage renal disease dialysis with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/27/2006 and was last updated on 6/4/2020.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentN/AILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1100004743MEDICAIDWISCONSIN

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

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