39D2051290 CLIA NUMBER - GRANT ONE DIALYSIS

Laboratory Demographics

  • CLIA Code: 39D2051290
  • Facility Name: GRANT ONE DIALYSIS
  • Facility Address: 9475 ROOSEVELT BLVD, SUITE 9
    PHILADELPHIA, PA
    ZIP 19114
  • Facility Phone: 215 677-3707
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. LAWRENCE FREITAS
  • NPI Number: 1497004113
  • Taxonomy: 261QE0700X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 39D2051290
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name GRANT ONE DIALYSIS
Street 9475 ROOSEVELT BLVD, SUITE 9
City PHILADELPHIA
State PA
ZIP 19114
Phone 215 677-3707
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2024
Certificate Expiration Date 12/16/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. LAWRENCE FREITAS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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