12D2205055 CLIA NUMBER - USRC WAIANAE, LLC DBA US RENAL CARE WAIANAE DIALYSIS

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Laboratory Demographics

CLIA Number: 12D2205055

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

Facility Address:
86-120 FARRINGTON HWY, STE B211
WAIANAE, HI
ZIP 96792
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Facility Phone Number: 808 664-8350

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1578160909

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	12D2205055
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	USRC WAIANAE, LLC DBA US RENAL CARE WAIANAE DIALYSIS
Street	86-120 FARRINGTON HWY, STE B211
City	WAIANAE
State	HI
ZIP	96792
Phone	808 664-8350
CertificateType	4
CertificateEffectiveDate	12/11/2022
CertificateExpirationDate	12/10/2024
FacilityType	Waiver

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