45D2198470 CLIA NUMBER - USRC BLUEBONNET HOME, LLC DBA US RENAL CARE BLUEBONNET HOME DIALYSIS

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Laboratory Demographics

CLIA Number: 45D2198470

Facility Name: USRC BLUEBONNET HOME, LLC DBA US RENAL CARE BLUEBONNET HOME DIALYSIS

Facility Address:
1902 WINDSOR PLACE SUITE 202
FORT WORTH, TX
ZIP 76110
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Facility Phone Number: 817 953-5511

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1609473941

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2198470
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	USRC BLUEBONNET HOME, LLC DBA US RENAL CARE BLUEBONNET HOME DIALYSIS
Street	1902 WINDSOR PLACE SUITE 202
City	FORT WORTH
State	TX
ZIP	76110
Phone	817 953-5511
CertificateType	4
CertificateEffectiveDate	11/2/2022
CertificateExpirationDate	11/1/2024
FacilityType	Waiver

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