05D0984014 CLIA NUMBER - VINELAND ADULT HEALTH CENTER

Laboratory Demographics

CLIA Number: 05D0984014

Facility Name: VINELAND ADULT HEALTH CENTER

Facility Address:
5629 VINELAND AVENUE
N HOLLYWOOD, CA
ZIP 91601
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Facility Phone Number: 818 753-0714

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1184820524

Taxonomy: 261QA0600X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D0984014
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	VINELAND ADULT HEALTH CENTER
Street	5629 VINELAND AVENUE
City	N HOLLYWOOD
State	CA
ZIP	91601
Phone	818 753-0714
CertificateType	4
CertificateEffectiveDate	3/12/2023
CertificateExpirationDate	3/11/2025
FacilityType	Waiver

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