12D1051948 CLIA NUMBER - LIBERTY DIALYSIS-HAWAII LLC-WEST KAUAI DIALYSIS

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Laboratory Demographics

CLIA Number: 12D1051948

Facility Name: LIBERTY DIALYSIS-HAWAII LLC-WEST KAUAI DIALYSIS

Facility Address:
4643-A WAIMEA CANYON RD
WAIMEA, HI
ZIP 96796
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Facility Phone Number: 808 338-1100

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1801832951

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	12D1051948
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	LIBERTY DIALYSIS-HAWAII LLC-WEST KAUAI DIALYSIS
Street	4643-A WAIMEA CANYON RD
City	WAIMEA
State	HI
ZIP	96796
Phone	808 338-1100
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