05D2064469 CLIA NUMBER - DIALYSIS CENTER OF PORTERVILLE, LLC

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Laboratory Demographics

CLIA Number: 05D2064469

Facility Name: DIALYSIS CENTER OF PORTERVILLE, LLC

Facility Address:
841 W HENDERSON AVE
PORTERVILLE, CA
ZIP 93257
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Facility Phone Number: 559 535-0600

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1326485293

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2064469
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	DIALYSIS CENTER OF PORTERVILLE, LLC
Street	841 W HENDERSON AVE
City	PORTERVILLE
State	CA
ZIP	93257
Phone	559 535-0600
CertificateType	4
CertificateEffectiveDate	8/20/2023
CertificateExpirationDate	8/19/2025
FacilityType	Waiver

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