32D2066055 CLIA NUMBER - LIBERTY NEW MEXICO PARTNERS 1 LLC

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Laboratory Demographics

CLIA Number: 32D2066055

Facility Name: LIBERTY NEW MEXICO PARTNERS 1 LLC

Facility Address:
3810 COMMONS AVE NE
ALBUQUERQUE, NM
ZIP 87109
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Facility Phone Number: 505 345-1224

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1336483221

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	32D2066055
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	LIBERTY NEW MEXICO PARTNERS 1 LLC
Street	3810 COMMONS AVE NE
City	ALBUQUERQUE
State	NM
ZIP	87109
Phone	505 345-1224
CertificateType	4
CertificateEffectiveDate	9/19/2023
CertificateExpirationDate	9/18/2025
FacilityType	Waiver

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