10D2109445 CLIA NUMBER - HOME DIALYSIS SERVICES NORTH TAMPA

Laboratory Demographics

CLIA Number: 10D2109445

Facility Name: HOME DIALYSIS SERVICES NORTH TAMPA

Facility Address:
7187 BROAD ST
BROOKSVILLE, FL
ZIP 34601
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Facility Phone Number: 708 640-1000

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1689056921

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2109445
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	HOME DIALYSIS SERVICES NORTH TAMPA
Street	7187 BROAD ST
City	BROOKSVILLE
State	FL
ZIP	34601
Phone	708 640-1000
CertificateType	4
CertificateEffectiveDate	2/25/2024
CertificateExpirationDate	2/24/2026
FacilityType	Waiver

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