02D2214567 CLIA NUMBER - ALTAIR INTEGRATIVE WELLNESS

Laboratory Demographics

CLIA Number: 02D2214567

Facility Name: ALTAIR INTEGRATIVE WELLNESS

Facility Address:
3161 E PALMER-WASILLA HWY, STE 1C
WASILLA, AK
ZIP 99654
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Facility Phone Number: 907 357-1818

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1932744836

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	02D2214567
LAB Type	Physician Office
Facility Name	ALTAIR INTEGRATIVE WELLNESS
Street	3161 E PALMER-WASILLA HWY, STE 1C
City	WASILLA
State	AK
ZIP	99654
Phone	907 357-1818
CertificateType	4
CertificateEffectiveDate	2/23/2023
CertificateExpirationDate	2/22/2025
FacilityType	Waiver

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