10D1004274 CLIA NUMBER - CONVIVA MEDICAL CENTER MANAGEMENT, LLC DBA CONVIVA CARE CENTER

Laboratory Demographics

CLIA Number: 10D1004274

Facility Name: CONVIVA MEDICAL CENTER MANAGEMENT, LLC DBA CONVIVA CARE CENTER

Facility Address:
692 N HOMESTEAD BOULEVARD, STE 102
HOMESTEAD, FL
ZIP 33030
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Facility Phone Number: 786 243-5930

Facility Type: Physician Office

Certificate Type: Waiver

CLIA Record

Field Name	Field Value
CLIA Number	10D1004274
LAB Type	Physician Office
Facility Name	CONVIVA MEDICAL CENTER MANAGEMENT, LLC DBA CONVIVA CARE CENTER
Street	692 N HOMESTEAD BOULEVARD, STE 102
City	HOMESTEAD
State	FL
ZIP	33030
Phone	786 243-5930
CertificateType	4
CertificateEffectiveDate	9/23/2022
CertificateExpirationDate	9/22/2024
FacilityType	Waiver

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