06D2237705 CLIA NUMBER - PONDEROSA PINE, LLC DBA - US RENAL CARE LONE TREE DIALYSIS

Laboratory Demographics

CLIA Number: 06D2237705

Facility Name: PONDEROSA PINE, LLC DBA - US RENAL CARE LONE TREE DIALYSIS

Facility Address:
9777 SOUTH YOSEMITE ST, SUITES 130 A,B,C
LONE TREE, CO
ZIP 80124
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Facility Phone Number: 720 798-3714

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1407525447

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	06D2237705
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	PONDEROSA PINE, LLC DBA - US RENAL CARE LONE TREE DIALYSIS
Street	9777 SOUTH YOSEMITE ST, SUITES 130 A,B,C
City	LONE TREE
State	CO
ZIP	80124
Phone	720 798-3714
CertificateType	4
CertificateEffectiveDate	9/28/2023
CertificateExpirationDate	9/27/2025
FacilityType	Waiver

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