Provider Demographics
NPI:1982775631
Name:CENTER FOR RENAL REPLACEMENT, LLC
Entity type:Organization
Organization Name:CENTER FOR RENAL REPLACEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR AND ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:YEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-675-5555
Mailing Address - Street 1:4354 W PRATT AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3544
Mailing Address - Country:US
Mailing Address - Phone:847-674-0071
Mailing Address - Fax:847-674-3878
Practice Address - Street 1:7301 N LINCOLN AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1709
Practice Address - Country:US
Practice Address - Phone:847-675-5555
Practice Address - Fax:847-675-7019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL50400OtherBLUE CROSS BLUE SHIELD
IL50400OtherBLUE CROSS BLUE SHIELD
IL=========001Medicaid