36D0907517 CLIA NUMBER - WILLOW DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 36D0907517

Facility Name: WILLOW DIALYSIS CENTER

Facility Address:
1675 ALEX DRIVE
WILMINGTON, OH
ZIP 45177
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Facility Phone Number: 937 383-3338

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1932165867

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D0907517
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WILLOW DIALYSIS CENTER
Street	1675 ALEX DRIVE
City	WILMINGTON
State	OH
ZIP	45177
Phone	937 383-3338
CertificateType	4
CertificateEffectiveDate	10/16/2023
CertificateExpirationDate	10/15/2025
FacilityType	Waiver

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