24D1004078 CLIA NUMBER - ST LOUIS PARK DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 24D1004078

Facility Name: ST LOUIS PARK DIALYSIS CENTER

Facility Address:
3505 LOUISIANA AVENUE SOUTH
SAINT LOUIS PARK, MN
ZIP 55426
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Facility Phone Number: 952 285-1400

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1447214812

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	24D1004078
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ST LOUIS PARK DIALYSIS CENTER
Street	3505 LOUISIANA AVENUE SOUTH
City	SAINT LOUIS PARK
State	MN
ZIP	55426
Phone	952 285-1400
CertificateType	4
CertificateEffectiveDate	7/20/2023
CertificateExpirationDate	7/19/2025
FacilityType	Waiver

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