12D1051941 CLIA NUMBER - LIBERTY DIALYSIS-HAWAII LLC-KAUAI DIALYSIS

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Laboratory Demographics

CLIA Number: 12D1051941

Facility Name: LIBERTY DIALYSIS-HAWAII LLC-KAUAI DIALYSIS

Facility Address:
3224 ELUA ST
LIHUE, HI
ZIP 96766
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Facility Phone Number: 808 245-3770

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1235171588

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	12D1051941
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	LIBERTY DIALYSIS-HAWAII LLC-KAUAI DIALYSIS
Street	3224 ELUA ST
City	LIHUE
State	HI
ZIP	96766
Phone	808 245-3770
CertificateType	4
CertificateEffectiveDate	8/19/2023
CertificateExpirationDate	8/18/2025
FacilityType	Waiver

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