14D1016004 CLIA NUMBER - BEVERLY DIALYSIS

Laboratory Demographics

CLIA Number: 14D1016004

Facility Name: BEVERLY DIALYSIS

Facility Address:
8109 SOUTH WESTERN AVE
CHICAGO, IL
ZIP 60620
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Facility Phone Number: (773) 778-0173

Facility Type: END STAGE RENAL DISEASE DIALYSIS

Certificate Type: Waiver

NPI Number: 1215023338

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1016004
LAB Type	END STAGE RENAL DISEASE DIALYSIS
Facility Name	BEVERLY DIALYSIS
Street	8109 SOUTH WESTERN AVE
City	CHICAGO
State	IL
ZIP	60620
Phone	(773) 778-0173

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This page was last updated on: 5/11/2023