19D0880085 CLIA NUMBER - FLEUR DE LIS DIALYSIS

Laboratory Demographics

CLIA Number: 19D0880085

Facility Name: FLEUR DE LIS DIALYSIS

Facility Address:
5555 BULLARD AVENUE
NEW ORLEANS, LA
ZIP 70128
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Facility Phone Number: 504 240-2696

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1114986288

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D0880085
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FLEUR DE LIS DIALYSIS
Street	5555 BULLARD AVENUE
City	NEW ORLEANS
State	LA
ZIP	70128
Phone	504 240-2696
CertificateType	4
CertificateEffectiveDate	12/7/2023
CertificateExpirationDate	12/6/2025
FacilityType	Waiver

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