NPIMap

Renal Treatment Centers-Illinois Inc

Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Bourbonnais, IL

NPI 1073675138 · NPPES record last updated Mar 7, 2023

Key facts

NPI
1073675138
Entity type
Organization (NPI type 2)
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
Legal business name
RENAL TREATMENT CENTERS-ILLINOIS INC
Practice address
581 William R Latham Sr Dr Ste 104
Bourbonnais, IL 60914-2439
Phone
(815) 936-3088
Fax
(815) 936-3756
NPI assigned
Dec 15, 2006
Organization subpart
No

Authorized official

Name
John Winstel
Title
Chief Accounting Officer
Phone
(253) 733-4501

Corporate family (same tax ID) 13

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 80

Organizations listed as members of this organization in the National Provider Directory.

View all 80

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Medicare Care Compare: Dialysis facility

Listed as
DaVita Kankakee County Dialysis CCN 142685
Overall star rating
★★☆☆☆ 2.0 of 5
Ownership
Profit
Certified
Sep 13, 2007
Medicare certification status
Active (Provider of Services file)
Chain
DaVita
Dialysis stations
16

Source: Medicare Care Compare. Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1064891Kankakee County Dialysis
581 William Latham Drive Suite 104, Bourbonnais, IL 60914		Certificate of waiverFeb 14, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20070208000255 IL Part a Provider - End-Stage Renal Disease Facility (ESRD) 2365359965 Practice locations: Bourbonnais, IL

National Provider Directory

Tax ID family
Renal Treatment Centers - Illinois Inc (85 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Yes

Addresses

Primary practice location

581 William R Latham Sr Dr Ste 104
Bourbonnais, IL 60914-2439

Mailing address

5200 Virginia Way
L&C Dept
Brentwood, TN 37027-7569
Phone (615) 320-4514

Other names

  • Kankakee County Dialysis Doing business as

Other providers in Bourbonnais, IL

All providers in Bourbonnais, IL · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Illinois

Sources for this page

Verify at the official NPI Registry.