14D1064891 CLIA NUMBER - KANKAKEE COUNTY DIALYSIS

Laboratory Demographics

CLIA Number: 14D1064891

Facility Name: KANKAKEE COUNTY DIALYSIS

Facility Address:
581 WILLIAM LATHAM DRIVE SUITE 104
BOURBONNAIS, IL
ZIP 60914
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Facility Phone Number: 815 936-3088

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1073675138

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1064891
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	KANKAKEE COUNTY DIALYSIS
Street	581 WILLIAM LATHAM DRIVE SUITE 104
City	BOURBONNAIS
State	IL
ZIP	60914
Phone	815 936-3088
CertificateType	4
CertificateEffectiveDate	2/15/2023
CertificateExpirationDate	2/14/2025
FacilityType	Waiver

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