39D0657704 CLIA NUMBER - WAVERLY DIALYSIS

Laboratory Demographics

CLIA Number: 39D0657704

Facility Name: WAVERLY DIALYSIS

Facility Address:
407 E BALTIMORE PIKE WAVERLY SQUARE
MORTON, PA
ZIP 19070
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Facility Phone Number: 610 690-1100

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1619939311

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D0657704
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WAVERLY DIALYSIS
Street	407 E BALTIMORE PIKE WAVERLY SQUARE
City	MORTON
State	PA
ZIP	19070
Phone	610 690-1100
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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