10D2065782 CLIA NUMBER - PROVIDIA HOME CARE LLC

Laboratory Demographics

  • CLIA Code: 10D2065782
  • Facility Name: PROVIDIA HOME CARE LLC
  • Facility Address: 3560 KRAFT ROAD #301
    NAPLES, FL
    ZIP 34105
  • Facility Phone: 239 262-2400
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: AMY M. MONTGOMERY
  • NPI Number: 1780184218
  • Taxonomy: 2086S0129X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 10D2065782
LAB Type Home Health Agency
Facility Name PROVIDIA HOME CARE LLC
Street 3560 KRAFT ROAD #301
City NAPLES
State FL
ZIP 34105
Phone 239 262-2400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/16/2025
Certificate Expiration Date 9/15/2027
Facility Type Home Health Agency
Lab Director AMY M. MONTGOMERY

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