14D1014618 CLIA NUMBER - ROCKFORD DIALYSIS

Laboratory Demographics

CLIA Number: 14D1014618

Facility Name: ROCKFORD DIALYSIS

Facility Address:
3339 N ROCKTON AVE
ROCKFORD, IL
ZIP 61103
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Facility Phone Number: 815 636-4493

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1235198235

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1014618
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ROCKFORD DIALYSIS
Street	3339 N ROCKTON AVE
City	ROCKFORD
State	IL
ZIP	61103
Phone	815 636-4493
CertificateType	4
CertificateEffectiveDate	7/11/2023
CertificateExpirationDate	7/10/2025
FacilityType	Waiver

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