10D1073575 CLIA NUMBER - REGENCY DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 10D1073575

Facility Name: REGENCY DIALYSIS CENTER

Facility Address:
9535 REGENCY SQUARE BLVD N
JACKSONVILLE, FL
ZIP 32225
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Facility Phone Number: 904 725-0526

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1821291147

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1073575
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	REGENCY DIALYSIS CENTER
Street	9535 REGENCY SQUARE BLVD N
City	JACKSONVILLE
State	FL
ZIP	32225
Phone	904 725-0526
CertificateType	4
CertificateEffectiveDate	9/12/2023
CertificateExpirationDate	9/11/2025
FacilityType	Waiver

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