14D2047370 CLIA NUMBER - SHILOH DIALYSIS (DBA) TOTAL RENAL CARE INC

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Laboratory Demographics

CLIA Number: 14D2047370

Facility Name: SHILOH DIALYSIS (DBA) TOTAL RENAL CARE INC

Facility Address:
1095 N GREEN MOUNT RD
BELLEVILLE, IL
ZIP 62221
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Facility Phone Number: 618 628-1108

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1871848895

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2047370
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SHILOH DIALYSIS (DBA) TOTAL RENAL CARE INC
Street	1095 N GREEN MOUNT RD
City	BELLEVILLE
State	IL
ZIP	62221
Phone	618 628-1108
CertificateType	4
CertificateEffectiveDate	9/21/2022
CertificateExpirationDate	9/20/2024
FacilityType	Waiver

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