10D2096687 CLIA NUMBER - FIRST PREVENTION AND DIALYSIS CENTER LLC

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Laboratory Demographics

CLIA Number: 10D2096687

Facility Name: FIRST PREVENTION AND DIALYSIS CENTER LLC

Facility Address:
17940 NW 27TH AVE
MIAMI GARDENS, FL
ZIP 33056
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Facility Phone Number: 305 318-3169

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1710373634

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2096687
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FIRST PREVENTION AND DIALYSIS CENTER LLC
Street	17940 NW 27TH AVE
City	MIAMI GARDENS
State	FL
ZIP	33056
Phone	305 318-3169
CertificateType	4
CertificateEffectiveDate	5/29/2023
CertificateExpirationDate	5/28/2025
FacilityType	Waiver

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