14D0973651 CLIA NUMBER - GREENWOOD AVENUE DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 14D0973651

Facility Name: GREENWOOD AVENUE DIALYSIS CENTER

Facility Address:
1111 EAST 87TH STREET, STE 700
CHICAGO, IL
ZIP 60619
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Facility Phone Number: 773 375-5668

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1669587408

Taxonomy: 261QE0700X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	1/10/2023
CertificateExpirationDate	1/9/2025
FacilityType	Waiver

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