| NPI | 1184660052 |
|---|---|
| Doing Business As | CRYSTAL LAKE DIALYSIS CENTER |
| Entity Type | Organization |
| Authorized Contact | SARA ANNE BRADY Chief Nursing Officer 208-371-7878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2023-01-10 |