14D2161729 CLIA NUMBER - SALT CREEK DIALYSIS AVERTRAIL DIALYSIS

Laboratory Demographics

  • CLIA Code: 14D2161729
  • Facility Name: SALT CREEK DIALYSIS AVERTRAIL DIALYSIS
  • Facility Address: 196 W NORTH AVE
    VILLA PARK, IL
    ZIP 60181
  • Facility Phone: 630 279-3350
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: ANKIT RAWAL
  • NPI Number: 1912482654
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2161729
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name SALT CREEK DIALYSIS AVERTRAIL DIALYSIS
Street 196 W NORTH AVE
City VILLA PARK
State IL
ZIP 60181
Phone 630 279-3350
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/8/2025
Certificate Expiration Date 2/7/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director ANKIT RAWAL

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This page was last updated on: 9/29/2025