42D1052012 CLIA NUMBER - NRA-HOLLYWOOD, SOUTH CAROLINA, LLC D/B/A HOLLYWOOD-RAVENEL DIALYSIS CLINIC

Home > CLIA Lookup > 42D1052012

Laboratory Demographics

CLIA Number: 42D1052012

Facility Name: NRA-HOLLYWOOD, SOUTH CAROLINA, LLC D/B/A HOLLYWOOD-RAVENEL DIALYSIS CLINIC

Facility Address:
5953 JACOBS POINT BLVD
RAVENEL, SC
ZIP 29470
Get Directions

Facility Phone Number: 843 571-4599

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1356384069

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	42D1052012
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	NRA-HOLLYWOOD, SOUTH CAROLINA, LLC D/B/A HOLLYWOOD-RAVENEL DIALYSIS CLINIC
Street	5953 JACOBS POINT BLVD
City	RAVENEL
State	SC
ZIP	29470
Phone	843 571-4599
CertificateType	4
CertificateEffectiveDate	3/15/2024
CertificateExpirationDate	3/14/2026
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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