05D2027538 CLIA NUMBER - DIALYSIS CLINIC, INC. - UKIAH

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Laboratory Demographics

CLIA Number: 05D2027538

Facility Name: DIALYSIS CLINIC, INC. - UKIAH

Facility Address:
275 SOUTH ORCHARD AVENUE
UKIAH, CA
ZIP 95482
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Facility Phone Number: 707 462-2024

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1336443282

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2027538
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	DIALYSIS CLINIC, INC. - UKIAH
Street	275 SOUTH ORCHARD AVENUE
City	UKIAH
State	CA
ZIP	95482
Phone	707 462-2024
CertificateType	4
CertificateEffectiveDate	7/27/2023
CertificateExpirationDate	7/26/2025
FacilityType	Waiver

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