10D2130013 CLIA NUMBER - WEST ORANGE ORLANDO DIALYSIS CENTER LLC

Laboratory Demographics

CLIA Number: 10D2130013

Facility Name: WEST ORANGE ORLANDO DIALYSIS CENTER LLC

Facility Address:
828 MERCY DRIVE STE 2
ORLANDO, FL
ZIP 32808
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Facility Phone Number: 321 710-4362

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1861933699

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2130013
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WEST ORANGE ORLANDO DIALYSIS CENTER LLC
Street	828 MERCY DRIVE STE 2
City	ORLANDO
State	FL
ZIP	32808
Phone	321 710-4362
CertificateType	4
CertificateEffectiveDate	5/1/2023
CertificateExpirationDate	4/30/2025
FacilityType	Waiver

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