15D1059363 CLIA NUMBER - LIBERTY DIALYSIS-DUNELAND, LLC DBA DUNELAND DIALYSIS COFFEE CREEK

Laboratory Demographics

CLIA Number: 15D1059363

Facility Name: LIBERTY DIALYSIS-DUNELAND, LLC DBA DUNELAND DIALYSIS COFFEE CREEK

Facility Address:
3100 VILLAGE POINT STE 101
CHESTERTON, IN
ZIP 46304
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Facility Phone Number: 219 395-8020

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1457383069

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D1059363
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	LIBERTY DIALYSIS-DUNELAND, LLC DBA DUNELAND DIALYSIS COFFEE CREEK
Street	3100 VILLAGE POINT STE 101
City	CHESTERTON
State	IN
ZIP	46304
Phone	219 395-8020
CertificateType	4
CertificateEffectiveDate	9/28/2022
CertificateExpirationDate	9/27/2024
FacilityType	Waiver

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