39D2106377 CLIA NUMBER - BROWN STREET DIALYSIS

Laboratory Demographics

CLIA Number: 39D2106377

Facility Name: BROWN STREET DIALYSIS

Facility Address:
4800 BROWN STREET, SUITE 201
PHILADELPHIA, PA
ZIP 19139
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Facility Phone Number: 215 581-4993

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1417566621

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D2106377
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	BROWN STREET DIALYSIS
Street	4800 BROWN STREET, SUITE 201
City	PHILADELPHIA
State	PA
ZIP	19139
Phone	215 581-4993
CertificateType	4
CertificateEffectiveDate	12/17/2023
CertificateExpirationDate	12/16/2025
FacilityType	Waiver

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