14D2043893 CLIA NUMBER - GLEN DIALYSIS TOTAL RENAL CARE INC

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Laboratory Demographics

CLIA Number: 14D2043893

Facility Name: GLEN DIALYSIS TOTAL RENAL CARE INC

Facility Address:
2601 COMPASS RD, STE 145
GLENVIEW, IL
ZIP 60026
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Facility Phone Number: 847 268-3091

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1568957637

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2043893
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	GLEN DIALYSIS TOTAL RENAL CARE INC
Street	2601 COMPASS RD, STE 145
City	GLENVIEW
State	IL
ZIP	60026
Phone	847 268-3091
CertificateType	4
CertificateEffectiveDate	7/12/2022
CertificateExpirationDate	7/11/2024
FacilityType	Waiver

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