Healthcare Provider Details

I. General information

NPI: 1891301370
Provider Name (Legal Business Name): ANN COOK DIALYSIS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2020
Last Update Date: 03/04/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22525 E 8 MILE RD
SAINT CLAIR SHORES MI
48080-2433
US

IV. Provider business mailing address

22525 E 8 MILE RD
SAINT CLAIR SHORES MI
48080-2433
US

V. Phone/Fax

Practice location:
  • Phone: 175-420-7563
  • Fax:
Mailing address:
  • Phone: 313-451-0405
  • Fax: 586-999-8836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAKEISHA ZEIGLER
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 754-207-5634