42D1088784 CLIA NUMBER - LONGS DIALYSIS

Laboratory Demographics

CLIA Number: 42D1088784

Facility Name: LONGS DIALYSIS

Facility Address:
90 CLOVERLEAF DR, STE 306
LONGS, SC
ZIP 29568
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Facility Phone Number: 843 399-5275

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1083885776

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	42D1088784
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	LONGS DIALYSIS
Street	90 CLOVERLEAF DR, STE 306
City	LONGS
State	SC
ZIP	29568
Phone	843 399-5275
CertificateType	4
CertificateEffectiveDate	9/4/2022
CertificateExpirationDate	9/3/2024
FacilityType	Waiver

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