14D1067101 CLIA NUMBER - EDENS HOME DIALYSIS TOTAL RENAL CARE INC

Laboratory Demographics

CLIA Number: 14D1067101

Facility Name: EDENS HOME DIALYSIS TOTAL RENAL CARE INC

Facility Address:
8950 GROSS POINT RD, STE 300
SKOKIE, IL
ZIP 60077
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Facility Phone Number: 874 886-3225

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1780179838

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1067101
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	EDENS HOME DIALYSIS TOTAL RENAL CARE INC
Street	8950 GROSS POINT RD, STE 300
City	SKOKIE
State	IL
ZIP	60077
Phone	874 886-3225
CertificateType	4
CertificateEffectiveDate	4/10/2023
CertificateExpirationDate	4/9/2025
FacilityType	Waiver

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