39D2156471 CLIA NUMBER - ROOSEVELT AVENUE DIALYSIS

Laboratory Demographics

CLIA Number: 39D2156471

Facility Name: ROOSEVELT AVENUE DIALYSIS

Facility Address:
1695 ROOSEVELT AVE, SUITE A
YORK, PA
ZIP 17408
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Facility Phone Number: 717 767-0189

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1881170504

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D2156471
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ROOSEVELT AVENUE DIALYSIS
Street	1695 ROOSEVELT AVE, SUITE A
City	YORK
State	PA
ZIP	17408
Phone	717 767-0189
CertificateType	4
CertificateEffectiveDate	10/18/2022
CertificateExpirationDate	10/17/2024
FacilityType	Waiver

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