03D1008810 CLIA NUMBER - RENAL CARE GROUP-SAN CARLOS

Laboratory Demographics

CLIA Number: 03D1008810

Facility Name: RENAL CARE GROUP-SAN CARLOS

Facility Address:
860 US HWY 70
PERIDOT, AZ
ZIP 85542
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Facility Phone Number: 928 475-5987

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1487756656

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D1008810
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	RENAL CARE GROUP-SAN CARLOS
Street	860 US HWY 70
City	PERIDOT
State	AZ
ZIP	85542
Phone	928 475-5987
CertificateType	4
CertificateEffectiveDate	1/28/2023
CertificateExpirationDate	1/27/2025
FacilityType	Waiver

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