12D1051942 CLIA NUMBER - LIBERTY DIALYSIS-HAWAII LLC-MAUI DIALYSIS FACILITY

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Laboratory Demographics

CLIA Number: 12D1051942

Facility Name: LIBERTY DIALYSIS-HAWAII LLC-MAUI DIALYSIS FACILITY

Facility Address:
105 MAUI LANI PARKWAY
WAILUKU, HI
ZIP 96793
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Facility Phone Number: 808 244-9600

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1932140811

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	12D1051942
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	LIBERTY DIALYSIS-HAWAII LLC-MAUI DIALYSIS FACILITY
Street	105 MAUI LANI PARKWAY
City	WAILUKU
State	HI
ZIP	96793
Phone	808 244-9600
CertificateType	4
CertificateEffectiveDate	8/20/2023
CertificateExpirationDate	8/19/2025
FacilityType	Waiver

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