39D2143413 CLIA NUMBER - NORTHEAST PHILADELPHIA DIALYSIS CENTER, LLC

Laboratory Demographics

CLIA Number: 39D2143413

Facility Name: NORTHEAST PHILADELPHIA DIALYSIS CENTER, LLC

Facility Address:
9815 ROOSEVELT BLVD, SUITE 1A
PHILADELPHIA, PA
ZIP 19114
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Facility Phone Number: 215 330-0494

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1093229809

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D2143413
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	NORTHEAST PHILADELPHIA DIALYSIS CENTER, LLC
Street	9815 ROOSEVELT BLVD, SUITE 1A
City	PHILADELPHIA
State	PA
ZIP	19114
Phone	215 330-0494
CertificateType	4
CertificateEffectiveDate	1/30/2024
CertificateExpirationDate	1/29/2026
FacilityType	Waiver

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