23D1025265 CLIA NUMBER - RCG SOUTH HAVEN

Laboratory Demographics

CLIA Number: 23D1025265

Facility Name: RCG SOUTH HAVEN

Facility Address:
199 VETERANS BLVD
SOUTH HAVEN, MI
ZIP 49090
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Facility Phone Number: 269 639-1800

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1932214780

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D1025265
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	RCG SOUTH HAVEN
Street	199 VETERANS BLVD
City	SOUTH HAVEN
State	MI
ZIP	49090
Phone	269 639-1800
CertificateType	4
CertificateEffectiveDate	5/4/2024
CertificateExpirationDate	5/3/2026
FacilityType	Waiver

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