52D2102510 CLIA NUMBER - GREEN LAKE COUNTY DIALYSIS

Laboratory Demographics

CLIA Number: 52D2102510

Facility Name: GREEN LAKE COUNTY DIALYSIS

Facility Address:
432 OAK ST
BERLIN, WI
ZIP 54923
Get Directions

Facility Phone Number: 920 361-1177

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1235513912

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	52D2102510
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	GREEN LAKE COUNTY DIALYSIS
Street	432 OAK ST
City	BERLIN
State	WI
ZIP	54923
Phone	920 361-1177
CertificateType	4
CertificateEffectiveDate	9/24/2023
CertificateExpirationDate	9/23/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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