05D1007680 CLIA NUMBER - IMPERIAL CARE DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 05D1007680

Facility Name: IMPERIAL CARE DIALYSIS CENTER

Facility Address:
4345 E IMPERIAL HWY
LYNWOOD, CA
ZIP 90262
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Facility Phone Number: 310 900-0333

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1700845278

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1007680
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	IMPERIAL CARE DIALYSIS CENTER
Street	4345 E IMPERIAL HWY
City	LYNWOOD
State	CA
ZIP	90262
Phone	310 900-0333
CertificateType	4
CertificateEffectiveDate	12/26/2022
CertificateExpirationDate	12/25/2024
FacilityType	Waiver

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