14D0985286 CLIA NUMBER - BENTON DIALYSIS RENAL LIFE LINK INC

Laboratory Demographics

CLIA Number: 14D0985286

Facility Name: BENTON DIALYSIS RENAL LIFE LINK INC

Facility Address:
1151 ROUTE 14 WEST
BENTON, IL
ZIP 62812
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Facility Phone Number: 618 435-4850

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1609885185

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0985286
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	BENTON DIALYSIS RENAL LIFE LINK INC
Street	1151 ROUTE 14 WEST
City	BENTON
State	IL
ZIP	62812
Phone	618 435-4850
CertificateType	4
CertificateEffectiveDate	4/12/2023
CertificateExpirationDate	4/11/2025
FacilityType	Waiver

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