19D2112207 CLIA NUMBER - KENTWOOD HOME DIALYSIS, LLC

Laboratory Demographics

CLIA Number: 19D2112207

Facility Name: KENTWOOD HOME DIALYSIS, LLC

Facility Address:
800 3RD STREET, SUITE B
KENTWOOD, LA
ZIP 70444
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Facility Phone Number: 985 229-8738

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1306240684

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D2112207
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	KENTWOOD HOME DIALYSIS, LLC
Street	800 3RD STREET, SUITE B
City	KENTWOOD
State	LA
ZIP	70444
Phone	985 229-8738
CertificateType	4
CertificateEffectiveDate	4/25/2022
CertificateExpirationDate	4/24/2024
FacilityType	Waiver

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