10D2048858 CLIA NUMBER - GAINESVILLE HOME DIALYSIS

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Laboratory Demographics

CLIA Number: 10D2048858

Facility Name: GAINESVILLE HOME DIALYSIS

Facility Address:
4960 W NEWBERRY RD STE 280
GAINESVILLE, FL
ZIP 32607
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Facility Phone Number: 352 378-4960

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1447500343

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2048858
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	GAINESVILLE HOME DIALYSIS
Street	4960 W NEWBERRY RD STE 280
City	GAINESVILLE
State	FL
ZIP	32607
Phone	352 378-4960
CertificateType	4
CertificateEffectiveDate	10/25/2022
CertificateExpirationDate	10/24/2024
FacilityType	Waiver

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