39D2094836 CLIA NUMBER - GIRARD ESTATES DIALYSIS

Laboratory Demographics

  • CLIA Code: 39D2094836
  • Facility Name: GIRARD ESTATES DIALYSIS
  • Facility Address: 1930 SOUTH BROAD STREET
    PHILADELPHIA, PA
    ZIP 19145
  • Facility Phone: 215 463-3120
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. LARRY E. KREVOLIN
  • NPI Number: 1295344307
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 39D2094836
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name GIRARD ESTATES DIALYSIS
Street 1930 SOUTH BROAD STREET
City PHILADELPHIA
State PA
ZIP 19145
Phone 215 463-3120
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/24/2025
Certificate Expiration Date 4/23/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. LARRY E. KREVOLIN

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