Healthcare Provider Details

I. General information

NPI: 1528432697
Provider Name (Legal Business Name): GLOBAL DIALYSIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9746 SOUTH HARVARD AVE.
CHICAGO IL
60628
US

IV. Provider business mailing address

9746 SOUTH HARVARD AVE.
CHICAGO IL
60628
US

V. Phone/Fax

Practice location:
  • Phone: 708-297-5368
  • Fax:
Mailing address:
  • Phone: 708-297-5368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. JULIUS WATKINS
Title or Position: FOUNDER/CEO
Credential:
Phone: 708-297-5368