13D2013218 CLIA NUMBER - LIBERTY DIALYSIS CALDWELL

Laboratory Demographics

  • CLIA Code: 13D2013218
  • Facility Name: LIBERTY DIALYSIS CALDWELL
  • Facility Address: 4620 ENTERPRISE WAY STE 101
    CALDWELL, ID
    ZIP 83605
  • Facility Phone: 208 454-1101
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JOEL GROOMS
  • NPI Number: 1255643243
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 13D2013218
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LIBERTY DIALYSIS CALDWELL
Street 4620 ENTERPRISE WAY STE 101
City CALDWELL
State ID
ZIP 83605
Phone 208 454-1101
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2025
Certificate Expiration Date 9/16/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director JOEL GROOMS

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This page was last updated on: 9/29/2025