07D1005141 CLIA NUMBER - PROSPECT CT MEDICAL FOUNDATION INC ECMP

Laboratory Demographics

CLIA Number: 07D1005141

Facility Name: PROSPECT CT MEDICAL FOUNDATION INC ECMP

Facility Address:
6 FIELDSTONE COMMONS STE D
TOLLAND, CT
ZIP 06084
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Facility Phone Number: 860 871-6710

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1518314020

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	07D1005141
LAB Type	Physician Office
Facility Name	PROSPECT CT MEDICAL FOUNDATION INC ECMP
Street	6 FIELDSTONE COMMONS STE D
City	TOLLAND
State	CT
ZIP	06084
Phone	860 871-6710
CertificateType	4
CertificateEffectiveDate	10/16/2022
CertificateExpirationDate	10/15/2024
FacilityType	Waiver

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