14D0973651 CLIA NUMBER - GREENWOOD AVENUE DIALYSIS CENTER

Laboratory Demographics

  • CLIA Code: 14D0973651
  • Facility Name: GREENWOOD AVENUE DIALYSIS CENTER
  • Facility Address: 1111 EAST 87TH STREET, STE 700
    CHICAGO, IL
    ZIP 60619
  • Facility Phone: 773 375-5668
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MALATHI SHAH
  • NPI Number: 1669587408
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0973651
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name GREENWOOD AVENUE DIALYSIS CENTER
Street 1111 EAST 87TH STREET, STE 700
City CHICAGO
State IL
ZIP 60619
Phone 773 375-5668
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/10/2025
Certificate Expiration Date 1/9/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MALATHI SHAH

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