14D2033187 CLIA NUMBER - CRIMSON RIDGE HOME TRAINING (D/B/A) DIALYSIS OF NORTHERN ILLINOIS LLC

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Laboratory Demographics

CLIA Number: 14D2033187

Facility Name: CRIMSON RIDGE HOME TRAINING (D/B/A) DIALYSIS OF NORTHERN ILLINOIS LLC

Facility Address:
2540 H AUSER ROSS DR STE 200
SYCAMORE, IL
ZIP 60178
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Facility Phone Number: 815 748-3508

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1184900920

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2033187
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	CRIMSON RIDGE HOME TRAINING (D/B/A) DIALYSIS OF NORTHERN ILLINOIS LLC
Street	2540 H AUSER ROSS DR STE 200
City	SYCAMORE
State	IL
ZIP	60178
Phone	815 748-3508
CertificateType	4
CertificateEffectiveDate	11/28/2023
CertificateExpirationDate	11/27/2025
FacilityType	Waiver

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