49D2129415 CLIA NUMBER - PURE LIFE RENAL OF LANSDOWNE, LLC

Laboratory Demographics

CLIA Number: 49D2129415

Facility Name: PURE LIFE RENAL OF LANSDOWNE, LLC

Facility Address:
19490 SANDRIDGE WAY, SUITE 140
LEESBURG, VA
ZIP 20176
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Facility Phone Number: 954 962-5733

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1073057295

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	49D2129415
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	PURE LIFE RENAL OF LANSDOWNE, LLC
Street	19490 SANDRIDGE WAY, SUITE 140
City	LEESBURG
State	VA
ZIP	20176
Phone	954 962-5733
CertificateType	4
CertificateEffectiveDate	4/18/2023
CertificateExpirationDate	4/17/2025
FacilityType	Waiver

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