14D0676589 CLIA NUMBER - US RENAL CARE SCOTTSDALE DIALYSIS DBA DIALYSIS NEWCO LLC

Laboratory Demographics

CLIA Number: 14D0676589

Facility Name: US RENAL CARE SCOTTSDALE DIALYSIS DBA DIALYSIS NEWCO LLC

Facility Address:
4651 W 79TH ST, SUITE 100
CHICAGO, IL
ZIP 60652
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Facility Phone Number: 773 582-8911

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1053696674

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0676589
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	US RENAL CARE SCOTTSDALE DIALYSIS DBA DIALYSIS NEWCO LLC
Street	4651 W 79TH ST, SUITE 100
City	CHICAGO
State	IL
ZIP	60652
Phone	773 582-8911
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