38D0965607 CLIA NUMBER - THC / PNRS RAINES DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 38D0965607

Facility Name: THC / PNRS RAINES DIALYSIS CENTER

Facility Address:
3201 19TH AVENUE
FOREST GROVE, OR
ZIP 97116
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Facility Phone Number: 503 359-0593

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1982716882

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D0965607
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	THC / PNRS RAINES DIALYSIS CENTER
Street	3201 19TH AVENUE
City	FOREST GROVE
State	OR
ZIP	97116
Phone	503 359-0593
CertificateType	4
CertificateEffectiveDate	1/1/2024
CertificateExpirationDate	12/31/2025
FacilityType	Waiver

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