10D2086100 CLIA NUMBER - WEST BOYNTON DIALYSIS

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Laboratory Demographics

CLIA Number: 10D2086100

Facility Name: WEST BOYNTON DIALYSIS

Facility Address:
10150 HAGEN RANCH RD STE 101
BOYNTON BEACH, FL
ZIP 33437
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Facility Phone Number: 561 736-6096

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1255732202

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2086100
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WEST BOYNTON DIALYSIS
Street	10150 HAGEN RANCH RD STE 101
City	BOYNTON BEACH
State	FL
ZIP	33437
Phone	561 736-6096
CertificateType	4
CertificateEffectiveDate	10/28/2022
CertificateExpirationDate	10/27/2024
FacilityType	Waiver

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