Provider Demographics
NPI:1215365366
Name:AFFILIATED DIALYSIS OF JOLIET LLC
Entity type:Organization
Organization Name:AFFILIATED DIALYSIS OF JOLIET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ASCHLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-894-1951
Mailing Address - Street 1:2462 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-1756
Mailing Address - Country:US
Mailing Address - Phone:309-698-1800
Mailing Address - Fax:309-713-1556
Practice Address - Street 1:1352 HOUBOLT RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-9215
Practice Address - Country:US
Practice Address - Phone:630-942-1111
Practice Address - Fax:630-942-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment