07D2157864 CLIA NUMBER - EMMAUS HEALTH LLC

Laboratory Demographics

CLIA Number: 07D2157864

Facility Name: EMMAUS HEALTH LLC

Facility Address:
945 MAIN ST STE 205
MANCHESTER, CT
ZIP 06040
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Facility Phone Number: 860 553-3020

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1922586809

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	07D2157864
LAB Type	Practitioner Other
Facility Name	EMMAUS HEALTH LLC
Street	945 MAIN ST STE 205
City	MANCHESTER
State	CT
ZIP	06040
Phone	860 553-3020
CertificateType	4
CertificateEffectiveDate	11/15/2022
CertificateExpirationDate	11/14/2024
FacilityType	Waiver

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