36D2109386 CLIA NUMBER - LIBERTY FOREST FAIR LLC DBA LIBERTY FOREST FAIR

Laboratory Demographics

  • CLIA Code: 36D2109386
  • Facility Name: LIBERTY FOREST FAIR LLC DBA LIBERTY FOREST FAIR
  • Facility Address: 1198 WEST KEMPER ROAD
    CINCINNATI, OH
    ZIP 45240
  • Facility Phone: 513 648-9175
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MUHAMMAD A. KHAN
  • NPI Number: 1578922936
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 36D2109386
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LIBERTY FOREST FAIR LLC DBA LIBERTY FOREST FAIR
Street 1198 WEST KEMPER ROAD
City CINCINNATI
State OH
ZIP 45240
Phone 513 648-9175
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/24/2024
Certificate Expiration Date 2/23/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MUHAMMAD A. KHAN

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This page was last updated on: 9/29/2025