10D0872712 CLIA NUMBER - LAKE WORTH DIALYSIS

Laboratory Demographics

CLIA Number: 10D0872712

Facility Name: LAKE WORTH DIALYSIS

Facility Address:
2459 S CONGRESS AVE #100
PALM SPRINGS, FL
ZIP 33406
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Facility Phone Number: 561 439-1532

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1184691503

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0872712
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	LAKE WORTH DIALYSIS
Street	2459 S CONGRESS AVE #100
City	PALM SPRINGS
State	FL
ZIP	33406
Phone	561 439-1532
CertificateType	4
CertificateEffectiveDate	7/1/2023
CertificateExpirationDate	6/30/2025
FacilityType	Waiver

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