Organization
COOK COUNTY
Active
Parent organization
COOK COUNTY
Other names
Provident Dialysis Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
COOK COUNTY
Authorized official
SCOTT ANDRLE (DIRECTOR OF MANAGED CARE)
(312) 864-4649
Entity
Organization
Contact information
Practice address
430 EAST 51ST PL, CHICAGO, IL 60615
(312) 864-0200
Mailing address
430 EAST 51ST PL, CHICAGO, IL 60615
(312) 864-0200
Taxonomy
Speciality
Code
Description
License number
State
2472R0900X
Renal Dialysis Technician
Primary
—
—
Other
Enumeration date
09/28/2020
Last updated
03/16/2022
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