05D0663421 CLIA NUMBER - MISSION HILLS DIALYSIS LLC

Laboratory Demographics

CLIA Number: 05D0663421

Facility Name: MISSION HILLS DIALYSIS LLC

Facility Address:
11550 INDIAN HILLS RD #100
MISSION HILLS, CA
ZIP 91345
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Facility Phone Number: 818 898-1724

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1669584561

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0663421
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MISSION HILLS DIALYSIS LLC
Street	11550 INDIAN HILLS RD #100
City	MISSION HILLS
State	CA
ZIP	91345
Phone	818 898-1724
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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