09D0903562 CLIA NUMBER - WASHINGTON SOUTHEAST DIALYSIS

Laboratory Demographics

CLIA Number: 09D0903562

Facility Name: WASHINGTON SOUTHEAST DIALYSIS

Facility Address:
3857-A PENNSYLVANIA AVENUE, SE
WASHINGTON, DC
ZIP 20020
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Facility Phone Number: 202 581-9440

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1033357348

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	09D0903562
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WASHINGTON SOUTHEAST DIALYSIS
Street	3857-A PENNSYLVANIA AVENUE, SE
City	WASHINGTON
State	DC
ZIP	20020
Phone	202 581-9440
CertificateType	4
CertificateEffectiveDate	7/25/2023
CertificateExpirationDate	7/24/2025
FacilityType	Waiver

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