10D1036096 CLIA NUMBER - EMBASSY LAKES ARTIFICIAL KIDNEY CENTER

Laboratory Demographics

CLIA Number: 10D1036096

Facility Name: EMBASSY LAKES ARTIFICIAL KIDNEY CENTER

Facility Address:
11011 SHERIDAN STREET STE 308
HOLLYWOOD, FL
ZIP 33026
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Facility Phone Number: 954 430-9166

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1205892122

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1036096
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	EMBASSY LAKES ARTIFICIAL KIDNEY CENTER
Street	11011 SHERIDAN STREET STE 308
City	HOLLYWOOD
State	FL
ZIP	33026
Phone	954 430-9166
CertificateType	4
CertificateEffectiveDate	1/20/2023
CertificateExpirationDate	1/19/2025
FacilityType	Waiver

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