34D2140966 CLIA NUMBER - FAYETTEVILLE ROAD DIALYSIS

Laboratory Demographics

CLIA Number: 34D2140966

Facility Name: FAYETTEVILLE ROAD DIALYSIS

Facility Address:
285 PARACLETE DRIVE
RAEFORD, NC
ZIP 28376
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Facility Phone Number: 910 878-0052

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1255844130

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D2140966
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FAYETTEVILLE ROAD DIALYSIS
Street	285 PARACLETE DRIVE
City	RAEFORD
State	NC
ZIP	28376
Phone	910 878-0052
CertificateType	4
CertificateEffectiveDate	12/5/2023
CertificateExpirationDate	12/4/2025
FacilityType	Waiver

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