14D0424639 CLIA NUMBER - EMERALD DIALYSIS

Laboratory Demographics

CLIA Number: 14D0424639

Facility Name: EMERALD DIALYSIS

Facility Address:
710 WEST 43RD STREET
CHICAGO, IL
ZIP 60609
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Facility Phone Number: 773 843-5668

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1578522215

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0424639
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	EMERALD DIALYSIS
Street	710 WEST 43RD STREET
City	CHICAGO
State	IL
ZIP	60609
Phone	773 843-5668
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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