02D1020558 CLIA NUMBER - KODIAK COMMUNITY HEALTH CENTER

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Laboratory Demographics

CLIA Number: 02D1020558

Facility Name: KODIAK COMMUNITY HEALTH CENTER

Facility Address:
1911 EAST REZANOF DRIVE
KODIAK, AK
ZIP 99615
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Facility Phone Number: 907 481-5000

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1326047044

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	02D1020558
LAB Type	Federally Qualified Health Center
Facility Name	KODIAK COMMUNITY HEALTH CENTER
Street	1911 EAST REZANOF DRIVE
City	KODIAK
State	AK
ZIP	99615
Phone	907 481-5000
CertificateType	4
CertificateEffectiveDate	12/23/2023
CertificateExpirationDate	12/22/2025
FacilityType	Waiver

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