10D2116091 CLIA NUMBER - LAKE GRAY DIALYSIS CENTER LLC DBA ARA COLLINS RD DIALYSIS CENTER LLC

Laboratory Demographics

  • CLIA Code: 10D2116091
  • Facility Name: LAKE GRAY DIALYSIS CENTER LLC DBA ARA COLLINS RD DIALYSIS CENTER LLC
  • Facility Address: 6196 LAKE GRAY BLVD STE 112
    JACKSONVILLE, FL
    ZIP 32244
  • Facility Phone: 904 390-7270
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JAMES D. BAKER
  • NPI Number: 1588017784
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2116091
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LAKE GRAY DIALYSIS CENTER LLC DBA ARA COLLINS RD DIALYSIS CENTER LLC
Street 6196 LAKE GRAY BLVD STE 112
City JACKSONVILLE
State FL
ZIP 32244
Phone 904 390-7270
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/19/2024
Certificate Expiration Date 7/18/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director JAMES D. BAKER

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This page was last updated on: 3/20/2025