14D1018794 CLIA NUMBER - MAPLE AVENUE KIDNEY CENTER

Laboratory Demographics

CLIA Number: 14D1018794

Facility Name: MAPLE AVENUE KIDNEY CENTER

Facility Address:
610 S MAPLE AVE-SUITE 4100
OAK PARK, IL
ZIP 60304
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Facility Phone Number: 708 660-4100

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1891707196

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1018794
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MAPLE AVENUE KIDNEY CENTER
Street	610 S MAPLE AVE-SUITE 4100
City	OAK PARK
State	IL
ZIP	60304
Phone	708 660-4100
CertificateType	4
CertificateEffectiveDate	1/8/2024
CertificateExpirationDate	1/7/2026
FacilityType	Waiver

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