10D1078884 CLIA NUMBER - PROVIDIA HOME CARE, LLC

Laboratory Demographics

  • CLIA Code: 10D1078884
  • Facility Name: PROVIDIA HOME CARE, LLC
  • Facility Address: 5292 SUMMERLIN COMMONS WAY - STE 1102
    FORT MYERS, FL
    ZIP 33907
  • Facility Phone: 239 425-2670
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: AMY M. MONTGOMERY
  • NPI Number: 1245409010
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 10D1078884
LAB Type Home Health Agency
Facility Name PROVIDIA HOME CARE, LLC
Street 5292 SUMMERLIN COMMONS WAY - STE 1102
City FORT MYERS
State FL
ZIP 33907
Phone 239 425-2670
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/17/2024
Certificate Expiration Date 1/16/2026
Facility Type Home Health Agency
Lab Director AMY M. MONTGOMERY

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