39D2165614 CLIA NUMBER - OLD FORGE DIALYSIS

Laboratory Demographics

  • CLIA Code: 39D2165614
  • Facility Name: OLD FORGE DIALYSIS
  • Facility Address: 325 S MAIN ST
    OLD FORGE, PA
    ZIP 18518
  • Facility Phone: 570 457-3174
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. FERDINAND J. MANAHAN
  • NPI Number: 1467407791
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/2/2025
Certificate Expiration Date 5/1/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. FERDINAND J. MANAHAN

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This page was last updated on: 6/4/2025