15D1059008 CLIA NUMBER - LIBERTY DIALYSIS-DUNELAND, LLC DBA DUNELAND DIALYSIS LA PORTE

Laboratory Demographics

CLIA Number: 15D1059008

Facility Name: LIBERTY DIALYSIS-DUNELAND, LLC DBA DUNELAND DIALYSIS LA PORTE

Facility Address:
103 W 18TH ST
LA PORTE, IN
ZIP 46350
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Facility Phone Number: 219 326-6362

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1578598249

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D1059008
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	LIBERTY DIALYSIS-DUNELAND, LLC DBA DUNELAND DIALYSIS LA PORTE
Street	103 W 18TH ST
City	LA PORTE
State	IN
ZIP	46350
Phone	219 326-6362
CertificateType	4
CertificateEffectiveDate	9/20/2022
CertificateExpirationDate	9/19/2024
FacilityType	Waiver

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