23D2314754 CLIA NUMBER - GREAT LAKES DIALYSIS, LLC DBA DIALYSIS CARE CENTER GREAT LAKES EAST

Laboratory Demographics

  • CLIA Code: 23D2314754
  • Facility Name: GREAT LAKES DIALYSIS, LLC DBA DIALYSIS CARE CENTER GREAT LAKES EAST
  • Facility Address: 14614 KERCHEVAL AVENUE
    DETROIT, MI
    ZIP 48215
  • Facility Phone: 313 308-4200
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: BONIFACE TUBIE
  • NPI Number: 1720095417
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D2314754
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name GREAT LAKES DIALYSIS, LLC DBA DIALYSIS CARE CENTER GREAT LAKES EAST
Street 14614 KERCHEVAL AVENUE
City DETROIT
State MI
ZIP 48215
Phone 313 308-4200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/26/2024
Certificate Expiration Date 11/25/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director BONIFACE TUBIE

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This page was last updated on: 9/29/2025