01D2072485 CLIA NUMBER - MODEL CITY HOME TRAINING

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Laboratory Demographics

CLIA Number: 01D2072485

Facility Name: MODEL CITY HOME TRAINING

Facility Address:
1724 LEIGHTON AVE
ANNISTON, AL
ZIP 36207
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Facility Phone Number: 256 236-5864

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1669801643

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	01D2072485
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MODEL CITY HOME TRAINING
Street	1724 LEIGHTON AVE
City	ANNISTON
State	AL
ZIP	36207
Phone	256 236-5864
CertificateType	4
CertificateEffectiveDate	1/31/2024
CertificateExpirationDate	1/30/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024