31D2004930 CLIA NUMBER - LIBERTY DIALYSIS - HAMMONTON LLC

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Laboratory Demographics

CLIA Number: 31D2004930

Facility Name: LIBERTY DIALYSIS - HAMMONTON LLC

Facility Address:
392 N WHITE HORSE PIKE, SUITE 1
HAMMONTON, NJ
ZIP 08037
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Facility Phone Number: 609 561-0044

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1992967657

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	31D2004930
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	LIBERTY DIALYSIS - HAMMONTON LLC
Street	392 N WHITE HORSE PIKE, SUITE 1
City	HAMMONTON
State	NJ
ZIP	08037
Phone	609 561-0044
CertificateType	4
CertificateEffectiveDate	7/23/2022
CertificateExpirationDate	7/22/2024
FacilityType	Waiver

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