34D2089210 CLIA NUMBER - NEW RIVER DIALYSIS

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Laboratory Demographics

CLIA Number: 34D2089210

Facility Name: NEW RIVER DIALYSIS

Facility Address:
111 YOPP ROAD
JACKSONVILLE, NC
ZIP 28540
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Facility Phone Number: 910 989-0157

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1912307596

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D2089210
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	NEW RIVER DIALYSIS
Street	111 YOPP ROAD
City	JACKSONVILLE
State	NC
ZIP	28540
Phone	910 989-0157
CertificateType	4
CertificateEffectiveDate	12/22/2022
CertificateExpirationDate	12/21/2024
FacilityType	Waiver

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