06D2124990 CLIA NUMBER - LAKEWOOD FAMILY HEALTH CLINIC, LLC

Laboratory Demographics

CLIA Number: 06D2124990

Facility Name: LAKEWOOD FAMILY HEALTH CLINIC, LLC

Facility Address:
1990 SOUTH GARRISON ST #1
LAKEWOOD, CO
ZIP 80227
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Facility Phone Number: 303 578-8191

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1073050225

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	06D2124990
LAB Type	Practitioner Other
Facility Name	LAKEWOOD FAMILY HEALTH CLINIC, LLC
Street	1990 SOUTH GARRISON ST #1
City	LAKEWOOD
State	CO
ZIP	80227
Phone	303 578-8191
CertificateType	4
CertificateEffectiveDate	1/30/2023
CertificateExpirationDate	1/29/2025
FacilityType	Waiver

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