12D0967956 CLIA NUMBER - USRC PEARLRIDGE, LLC DBA US RENAL CARE PEARLRIDGE DIALYSIS

Laboratory Demographics

CLIA Number: 12D0967956

Facility Name: USRC PEARLRIDGE, LLC DBA US RENAL CARE PEARLRIDGE DIALYSIS

Facility Address:
98-1005 MOANALUA ROAD, SUITE 420
AIEA, HI
ZIP 96701
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Facility Phone Number: 808 440-4800

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1710554571

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	12D0967956
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	USRC PEARLRIDGE, LLC DBA US RENAL CARE PEARLRIDGE DIALYSIS
Street	98-1005 MOANALUA ROAD, SUITE 420
City	AIEA
State	HI
ZIP	96701
Phone	808 440-4800
CertificateType	4
CertificateEffectiveDate	2/27/2023
CertificateExpirationDate	2/26/2025
FacilityType	Waiver

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