07D2081397 CLIA NUMBER - PEDIATRIC HOUSE CALL SOLUTIONS

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Laboratory Demographics

CLIA Number: 07D2081397

Facility Name: PEDIATRIC HOUSE CALL SOLUTIONS

Facility Address:
167 CHERRY ST SUITE 112
MILFORD, CT
ZIP 06460
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Facility Phone Number: 203 893-5394

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1174928790

Taxonomy: 363LP0200X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	07D2081397
LAB Type	Practitioner Other
Facility Name	PEDIATRIC HOUSE CALL SOLUTIONS
Street	167 CHERRY ST SUITE 112
City	MILFORD
State	CT
ZIP	06460
Phone	203 893-5394
CertificateType	4
CertificateEffectiveDate	7/24/2022
CertificateExpirationDate	7/23/2024
FacilityType	Waiver

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