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39D2165614 CLIA NUMBER - OLD FORGE DIALYSIS

Laboratory Demographics

CLIA Number: 39D2165614

Facility Name: OLD FORGE DIALYSIS

Facility Address:
325 S MAIN ST
OLD FORGE, PA
ZIP 18518
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Facility Phone Number: 570 457-3174

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver
NPI Number: 1467407791

Taxonomy: 251300000X - Local Education Agency (LEA)
The term local education agency means a public board of education or other public authority legally constituted within a State to either provide administrative control or direction of, or perform a service function for public schools serving individuals ages 0 - 21 in a state, city, county, township, school district, or other political subdivision including a combination of school districts or counties recognized in a State as an administrative agency for its public schools. An LEA may provide, or employ professional who provide, services to children included in the Individuals with Disabilities Education Act (IDEA), such services may include, but are not limited to, such medical services as physical, occupational, and speech therapy.

CLIA Record

Field Name Field Value
CLIA Number 39D2165614
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name OLD FORGE DIALYSIS
Street 325 S MAIN ST
City OLD FORGE
State PA
ZIP 18518
Phone 570 457-3174
CertificateType 4
CertificateEffectiveDate 5/2/2023
CertificateExpirationDate 5/1/2025
FacilityType Waiver

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