34D0240771 CLIA NUMBER - WAKE DIALYSIS

Laboratory Demographics

CLIA Number: 34D0240771

Facility Name: WAKE DIALYSIS

Facility Address:
3604 BUSH STREET
RALEIGH, NC
ZIP 27609
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Facility Phone Number: 919 876-7501

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1780796508

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D0240771
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WAKE DIALYSIS
Street	3604 BUSH STREET
City	RALEIGH
State	NC
ZIP	27609
Phone	919 876-7501
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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