46D2104224 CLIA NUMBER - SOUTH OGDEN HOME

Laboratory Demographics

CLIA Number: 46D2104224

Facility Name: SOUTH OGDEN HOME

Facility Address:
475 E 40TH ST, STE 110
OGDEN, UT
ZIP 84403
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Facility Phone Number: 801 627-2886

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1770951030

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	46D2104224
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SOUTH OGDEN HOME
Street	475 E 40TH ST, STE 110
City	OGDEN
State	UT
ZIP	84403
Phone	801 627-2886
CertificateType	4
CertificateEffectiveDate	10/30/2023
CertificateExpirationDate	10/29/2025
FacilityType	Waiver

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