MEDICARE: DIALYSIS CARE CENTER AKRON LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1437652625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIALYSIS CARE CENTER AKRON LLC

Provider Business Mailing Address
First Line	:	PO BOX 3134
Second Line	:
City	:	JOLIET
State	:	IL
Zip	:	60434-3134
Country	:	US
Telephone Number	:	815-741-6830
Fax Number	:	815-741-6832

Provider Business Practice Location Address
First Line	:	1505 S HAWKINS AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-3418
Country	:	US
Telephone Number	:	330-612-0540
Fax Number	:	234-718-3840

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MORUFU ALAUSA
Credential	:	MD
Telephone Number	:	815-741-6830

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	10/12/2018

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