51D1021173 CLIA NUMBER - GREATER CHARLESTON DIAYLSIS

Laboratory Demographics

CLIA Number: 51D1021173

Facility Name: GREATER CHARLESTON DIAYLSIS

Facility Address:
24 MACCORKLE AVENUE SW 1ST FLOOR
SOUTH CHARLESTON, WV
ZIP 25303
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Facility Phone Number: 304 720-2222

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1679568778

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	51D1021173
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	GREATER CHARLESTON DIAYLSIS
Street	24 MACCORKLE AVENUE SW 1ST FLOOR
City	SOUTH CHARLESTON
State	WV
ZIP	25303
Phone	304 720-2222
CertificateType	4
CertificateEffectiveDate	1/14/2024
CertificateExpirationDate	1/13/2026
FacilityType	Waiver

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