14D2124654 CLIA NUMBER - FRESENIUS KIDNEY CARE HUMBOLDT PARK

Laboratory Demographics

CLIA Number: 14D2124654

Facility Name: FRESENIUS KIDNEY CARE HUMBOLDT PARK

Facility Address:
3520 WEST GRAND AVE
CHICAGO, IL
ZIP 60651
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Facility Phone Number: 773 276-6802

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1639628415

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2124654
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FRESENIUS KIDNEY CARE HUMBOLDT PARK
Street	3520 WEST GRAND AVE
City	CHICAGO
State	IL
ZIP	60651
Phone	773 276-6802
CertificateType	4
CertificateEffectiveDate	1/23/2023
CertificateExpirationDate	1/22/2025
FacilityType	Waiver

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