32D2232197 CLIA NUMBER - TAOS HOME DIALYSIS

Laboratory Demographics

CLIA Number: 32D2232197

Facility Name: TAOS HOME DIALYSIS

Facility Address:
1415 WEIMER RD
TAOS, NM
ZIP 87571
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Facility Phone Number: 575 999-6100

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1508456229

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	32D2232197
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	TAOS HOME DIALYSIS
Street	1415 WEIMER RD
City	TAOS
State	NM
ZIP	87571
Phone	575 999-6100
CertificateType	4
CertificateEffectiveDate	8/11/2023
CertificateExpirationDate	8/10/2025
FacilityType	Waiver

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