14D2065121 CLIA NUMBER - S A H DIALYSIS CLINIC AT 26TH STREET

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Laboratory Demographics

CLIA Number: 14D2065121

Facility Name: S A H DIALYSIS CLINIC AT 26TH STREET

Facility Address:
3059 WEST 26TH ST
CHICAGO, IL
ZIP 60623
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Facility Phone Number: 773 696-9470

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1861831315

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2065121
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	S A H DIALYSIS CLINIC AT 26TH STREET
Street	3059 WEST 26TH ST
City	CHICAGO
State	IL
ZIP	60623
Phone	773 696-9470
CertificateType	4
CertificateEffectiveDate	9/4/2023
CertificateExpirationDate	9/3/2025
FacilityType	Waiver

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