23D2041366 CLIA NUMBER - GREENFIELD HEALTH SYSTEM 2ND AVE DIALYSIS

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Laboratory Demographics

CLIA Number: 23D2041366

Facility Name: GREENFIELD HEALTH SYSTEM 2ND AVE DIALYSIS

Facility Address:
6525 2ND AVENUE
DETROIT, MI
ZIP 48202
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Facility Phone Number: 313 916-7062

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1053331322

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D2041366
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	GREENFIELD HEALTH SYSTEM 2ND AVE DIALYSIS
Street	6525 2ND AVENUE
City	DETROIT
State	MI
ZIP	48202
Phone	313 916-7062
CertificateType	4
CertificateEffectiveDate	5/22/2022
CertificateExpirationDate	5/21/2024
FacilityType	Waiver

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