15D1007202 CLIA NUMBER - COMPREHENSIVE RENAL CARE - MUNSTER

Laboratory Demographics

CLIA Number: 15D1007202

Facility Name: COMPREHENSIVE RENAL CARE - MUNSTER

Facility Address:
9100 CALUMET AVE
MUNSTER, IN
ZIP 46321
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Facility Phone Number: 219 836-1299

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1699738484

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D1007202
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	COMPREHENSIVE RENAL CARE - MUNSTER
Street	9100 CALUMET AVE
City	MUNSTER
State	IN
ZIP	46321
Phone	219 836-1299
CertificateType	4
CertificateEffectiveDate	12/11/2022
CertificateExpirationDate	12/10/2024
FacilityType	Waiver

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