16D2086335 CLIA NUMBER - EA MOTTO DIALYSIS CLYFEE DIALYSIS, LLC

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Laboratory Demographics

CLIA Number: 16D2086335

Facility Name: EA MOTTO DIALYSIS CLYFEE DIALYSIS, LLC

Facility Address:
1228 E RUSHOLME STREET, SUITE 1000
DAVENPORT, IA
ZIP 52803
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Facility Phone Number: 563 421-6440

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1821499245

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	16D2086335
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	EA MOTTO DIALYSIS CLYFEE DIALYSIS, LLC
Street	1228 E RUSHOLME STREET, SUITE 1000
City	DAVENPORT
State	IA
ZIP	52803
Phone	563 421-6440
CertificateType	4
CertificateEffectiveDate	10/31/2022
CertificateExpirationDate	10/30/2024
FacilityType	Waiver

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