05D0942642 CLIA NUMBER - KIDNEY INSTITUTE LOCATED AT EISENHOWER MEDICAL CENTER LLC

Laboratory Demographics

CLIA Number: 05D0942642

Facility Name: KIDNEY INSTITUTE LOCATED AT EISENHOWER MEDICAL CENTER LLC

Facility Address:
39000 BOB HOPE DR P-103
RANCHO MIRAGE, CA
ZIP 92270
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Facility Phone Number: 760 837-9696

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1922183045

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0942642
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	KIDNEY INSTITUTE LOCATED AT EISENHOWER MEDICAL CENTER LLC
Street	39000 BOB HOPE DR P-103
City	RANCHO MIRAGE
State	CA
ZIP	92270
Phone	760 837-9696
CertificateType	4
CertificateEffectiveDate	3/13/2024
CertificateExpirationDate	3/12/2026
FacilityType	Waiver

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