Provider Demographics
NPI:1043982101
Name:ANN COOK DIALYSIS CENTER
Entity type:Organization
Organization Name:ANN COOK DIALYSIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAKEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:586-496-3933
Mailing Address - Street 1:2727 2ND AVE STE 266
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2675
Mailing Address - Country:US
Mailing Address - Phone:313-451-0405
Mailing Address - Fax:586-999-8836
Practice Address - Street 1:2727 2ND AVE STE 266
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2675
Practice Address - Country:US
Practice Address - Phone:313-451-0405
Practice Address - Fax:586-999-8836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment