10D2121790 CLIA NUMBER - RENVIVA DIALYSIS CENTER OF CLEARWATER LLC

Laboratory Demographics

CLIA Number: 10D2121790

Facility Name: RENVIVA DIALYSIS CENTER OF CLEARWATER LLC

Facility Address:
401 CORBETT ST STE 250
BELLEAIR, FL
ZIP 33756
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Facility Phone Number: 727 281-4490

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1194178889

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2121790
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	RENVIVA DIALYSIS CENTER OF CLEARWATER LLC
Street	401 CORBETT ST STE 250
City	BELLEAIR
State	FL
ZIP	33756
Phone	727 281-4490
CertificateType	4
CertificateEffectiveDate	11/15/2022
CertificateExpirationDate	11/14/2024
FacilityType	Waiver

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