05D1083687 CLIA NUMBER - RAI OAKLAND HOME PROGRAM I

Laboratory Demographics

CLIA Number: 05D1083687

Facility Name: RAI OAKLAND HOME PROGRAM I

Facility Address:
2710 TELEGRAPH AVENUE SUITE 205
OAKLAND, CA
ZIP 94612
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Facility Phone Number: 510 452-8302

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1619164712

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D1083687
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	RAI OAKLAND HOME PROGRAM I
Street	2710 TELEGRAPH AVENUE SUITE 205
City	OAKLAND
State	CA
ZIP	94612
Phone	510 452-8302
CertificateType	4
CertificateEffectiveDate	5/8/2024
CertificateExpirationDate	5/7/2026
FacilityType	Waiver

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