| NPI | 1497703136 |
|---|---|
| Other Name | CRYSTAL LAKE AMBUTAL - RENAL DIALYSIS |
| Entity Type | Organization |
| Authorized Contact | ERIC RICHARD KRUEGER Vice President Of Finance/CFO 847-429-8718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment (Licence: IL 0002162) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2020-08-22 |