10D2042406 CLIA NUMBER - COASTAL DIALYSIS CENTER

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Laboratory Demographics

CLIA Number: 10D2042406

Facility Name: COASTAL DIALYSIS CENTER

Facility Address:
641 UNIVERSITY BLVD STE 209
JUPITER, FL
ZIP 33458
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Facility Phone Number: 561 557-1704

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1588920870

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2042406
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	COASTAL DIALYSIS CENTER
Street	641 UNIVERSITY BLVD STE 209
City	JUPITER
State	FL
ZIP	33458
Phone	561 557-1704
CertificateType	4
CertificateEffectiveDate	6/13/2022
CertificateExpirationDate	6/12/2024
FacilityType	Waiver

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