07D1086403 CLIA NUMBER - BLACK ROCK DIALYSIS

Laboratory Demographics

CLIA Number: 07D1086403

Facility Name: BLACK ROCK DIALYSIS

Facility Address:
427 STILLSON ROAD
FAIRFIELD, CT
ZIP 06824
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Facility Phone Number: 203 382-9566

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1558524512

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	07D1086403
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	BLACK ROCK DIALYSIS
Street	427 STILLSON ROAD
City	FAIRFIELD
State	CT
ZIP	06824
Phone	203 382-9566
CertificateType	4
CertificateEffectiveDate	7/11/2022
CertificateExpirationDate	7/10/2024
FacilityType	Waiver

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