14D1076289 CLIA NUMBER - ROSS DIALYSIS - ENGLEWOOD

Laboratory Demographics

CLIA Number: 14D1076289

Facility Name: ROSS DIALYSIS - ENGLEWOOD

Facility Address:
946 W 63RD ST
CHICAGO, IL
ZIP 60621
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Facility Phone Number: 773 873-2000

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1376524637

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1076289
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ROSS DIALYSIS - ENGLEWOOD
Street	946 W 63RD ST
City	CHICAGO
State	IL
ZIP	60621
Phone	773 873-2000
CertificateType	4
CertificateEffectiveDate	11/9/2023
CertificateExpirationDate	11/8/2025
FacilityType	Waiver

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