34D2046061 CLIA NUMBER - MINT HILL DIALYSIS

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Laboratory Demographics

CLIA Number: 34D2046061

Facility Name: MINT HILL DIALYSIS

Facility Address:
11308 HAWTHORNE DR
MINT HILL, NC
ZIP 28227
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Facility Phone Number: 704 573-2549

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1205116167

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D2046061
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MINT HILL DIALYSIS
Street	11308 HAWTHORNE DR
City	MINT HILL
State	NC
ZIP	28227
Phone	704 573-2549
CertificateType	4
CertificateEffectiveDate	8/24/2022
CertificateExpirationDate	8/23/2024
FacilityType	Waiver

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