14D0646533 CLIA NUMBER - DIALYSIS CENTERS OF AMERICA ILL INC

Laboratory Demographics

CLIA Number: 14D0646533

Facility Name: DIALYSIS CENTERS OF AMERICA ILL INC

Facility Address:
9160 W 159TH STREET
ORLAND PARK, IL
ZIP 60462
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Facility Phone Number: 708 403-2790

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1265547012

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0646533
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	DIALYSIS CENTERS OF AMERICA ILL INC
Street	9160 W 159TH STREET
City	ORLAND PARK
State	IL
ZIP	60462
Phone	708 403-2790
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