06D2146238 CLIA NUMBER - MOMENTA

Laboratory Demographics

  • CLIA Code: 06D2146238
  • Facility Name: MOMENTA
  • Facility Address: 3302 SOUTH GRAND AVE
    GLENWOOD SPRINGS, CO
    ZIP 81601
  • Facility Phone: 970 379-1193
  • Facility Type: Other - RESIDENTIAL TREATMENT CTR
  • Facility Type: Waiver
  • Lab Director: DR. RYAN JACKMAN
  • NPI Number: 1558850339
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 06D2146238
LAB Type Other - RESIDENTIAL TREATMENT CTR
Facility Name MOMENTA
Street 3302 SOUTH GRAND AVE
City GLENWOOD SPRINGS
State CO
ZIP 81601
Phone 970 379-1193
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/26/2024
Certificate Expiration Date 3/25/2026
Facility Type Other - RESIDENTIAL TREATMENT CTR
Lab Director DR. RYAN JACKMAN

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This page was last updated on: 9/29/2025