38D2180644 CLIA NUMBER - GLEN CREEK DIALYSIS

Laboratory Demographics

CLIA Number: 38D2180644

Facility Name: GLEN CREEK DIALYSIS

Facility Address:
645 9TH ST NW, SUITE 145
SALEM, OR
ZIP 97304
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Facility Phone Number: 503 365-6316

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1659839181

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D2180644
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	GLEN CREEK DIALYSIS
Street	645 9TH ST NW, SUITE 145
City	SALEM
State	OR
ZIP	97304
Phone	503 365-6316
CertificateType	4
CertificateEffectiveDate	3/18/2024
CertificateExpirationDate	3/17/2026
FacilityType	Waiver

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