14D2135471 CLIA NUMBER - WASHINGTON HEIGHTS DIALYSIS

Laboratory Demographics

CLIA Number: 14D2135471

Facility Name: WASHINGTON HEIGHTS DIALYSIS

Facility Address:
10620 S HALSTED STREET
CHICAGO, IL
ZIP 60628
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Facility Phone Number: 773 779-8149

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1558885228

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2135471
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WASHINGTON HEIGHTS DIALYSIS
Street	10620 S HALSTED STREET
City	CHICAGO
State	IL
ZIP	60628
Phone	773 779-8149
CertificateType	4
CertificateEffectiveDate	8/22/2023
CertificateExpirationDate	8/21/2025
FacilityType	Waiver

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