14D2159705 CLIA NUMBER - NORWOOD PARK DIALYSIS RENAL TREATMENT CENTER ILLINOIS, INC

Laboratory Demographics

CLIA Number: 14D2159705

Facility Name: NORWOOD PARK DIALYSIS RENAL TREATMENT CENTER ILLINOIS, INC

Facility Address:
7435 W TALCOTT AVE
CHICAGO, IL
ZIP 60631
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Facility Phone Number: 773 990-7620

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1396216206

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2159705
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	NORWOOD PARK DIALYSIS RENAL TREATMENT CENTER ILLINOIS, INC
Street	7435 W TALCOTT AVE
City	CHICAGO
State	IL
ZIP	60631
Phone	773 990-7620
CertificateType	4
CertificateEffectiveDate	12/24/2022
CertificateExpirationDate	12/23/2024
FacilityType	Waiver

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