19D0457738 CLIA NUMBER - CHATEAU DIALYSIS DVA HEALTHCARE RENAL CARE, INC

Laboratory Demographics

CLIA Number: 19D0457738

Facility Name: CHATEAU DIALYSIS DVA HEALTHCARE RENAL CARE, INC

Facility Address:
720 VILLAGE ROAD
KENNER, LA
ZIP 70065
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Facility Phone Number: 504 443-2895

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1477512515

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D0457738
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	CHATEAU DIALYSIS DVA HEALTHCARE RENAL CARE, INC
Street	720 VILLAGE ROAD
City	KENNER
State	LA
ZIP	70065
Phone	504 443-2895
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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