14D2067686 CLIA NUMBER - DIALYSIS CENTERS OF AMERICA - ILLINOIS INC

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Laboratory Demographics

CLIA Number: 14D2067686

Facility Name: DIALYSIS CENTERS OF AMERICA - ILLINOIS INC

Facility Address:
F M C GARFIELD 5401 S WENTWORTH, STE 18
CHICAGO, IL
ZIP 60609
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Facility Phone Number: 773 548-5714

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1174638928

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2067686
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	DIALYSIS CENTERS OF AMERICA - ILLINOIS INC
Street	F M C GARFIELD 5401 S WENTWORTH, STE 18
City	CHICAGO
State	IL
ZIP	60609
Phone	773 548-5714
CertificateType	4
CertificateEffectiveDate	10/21/2023
CertificateExpirationDate	10/20/2025
FacilityType	Waiver

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