1336509660 NPI number — OAKLAWN DIALYSIS CENTER OF ALBION, LLC

Table of content: LISA MARIE CARRILLO DPO 35 (NPI 1437679404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336509660 NPI number — OAKLAWN DIALYSIS CENTER OF ALBION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAKLAWN DIALYSIS CENTER OF ALBION, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336509660
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 B DR N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBION
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49224-8420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-654-1010
Provider Business Mailing Address Fax Number:
517-654-1011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 B DR N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBION
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49224-8420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-654-1010
Provider Business Practice Location Address Fax Number:
517-654-1011
Provider Enumeration Date:
02/29/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BLANTON
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
781-699-9000

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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