34D1104434 CLIA NUMBER - WAKE FOREST DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 34D1104434

Facility Name: WAKE FOREST DIALYSIS CENTER

Facility Address:
11001 INGLESIDE PLACE
RALEIGH, NC
ZIP 27614
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Facility Phone Number: 919 556-0968

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1992934749

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D1104434
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WAKE FOREST DIALYSIS CENTER
Street	11001 INGLESIDE PLACE
City	RALEIGH
State	NC
ZIP	27614
Phone	919 556-0968
CertificateType	4
CertificateEffectiveDate	9/3/2023
CertificateExpirationDate	9/2/2025
FacilityType	Waiver

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