33D2089859 CLIA NUMBER - MASSENA DIALYSIS CENTER LLC

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Laboratory Demographics

CLIA Number: 33D2089859

Facility Name: MASSENA DIALYSIS CENTER LLC

Facility Address:
290 MAIN STREET
MASSENA, NY
ZIP 13662
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Facility Phone Number: 315 705-0101

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1770989295

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D2089859
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MASSENA DIALYSIS CENTER LLC
Street	290 MAIN STREET
City	MASSENA
State	NY
ZIP	13662
Phone	315 705-0101
CertificateType	4
CertificateEffectiveDate	1/9/2015
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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