10D0715087 CLIA NUMBER - ORMOND BEACH DIALYSIS

Laboratory Demographics

CLIA Number: 10D0715087

Facility Name: ORMOND BEACH DIALYSIS

Facility Address:
420 SOUTH NOVA RD STE #7
ORMOND BEACH, FL
ZIP 32174
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Facility Phone Number: 386 676-2405

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1174591408

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0715087
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ORMOND BEACH DIALYSIS
Street	420 SOUTH NOVA RD STE #7
City	ORMOND BEACH
State	FL
ZIP	32174
Phone	386 676-2405
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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