14D2100335 CLIA NUMBER - ALSIP HOME TRAINING

Laboratory Demographics

CLIA Number: 14D2100335

Facility Name: ALSIP HOME TRAINING

Facility Address:
11500 S PULASKI RD
ALSIP, IL
ZIP 60803
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Facility Phone Number: 708 385-7145

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1720461742

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2100335
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ALSIP HOME TRAINING
Street	11500 S PULASKI RD
City	ALSIP
State	IL
ZIP	60803
Phone	708 385-7145
CertificateType	4
CertificateEffectiveDate	8/12/2023
CertificateExpirationDate	8/11/2025
FacilityType	Waiver

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