10D2176855 CLIA NUMBER - JACKSONVILLE HEALTH AND EDUCATIONAL RESOURCE CENTER, INC

Laboratory Demographics

CLIA Number: 10D2176855

Facility Name: JACKSONVILLE HEALTH AND EDUCATIONAL RESOURCE CENTER, INC

Facility Address:
1024 EDGEWOOD AVE W
JACKSONVILLE, FL
ZIP 32208
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Facility Phone Number: 904 503-2290

Facility Type: Other - COMMUNTIY BASED ORG.

Certificate Type: Waiver

NPI Number: 1083999114

Taxonomy: 261QD0000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2176855
LAB Type	Other - COMMUNTIY BASED ORG.
Facility Name	JACKSONVILLE HEALTH AND EDUCATIONAL RESOURCE CENTER, INC
Street	1024 EDGEWOOD AVE W
City	JACKSONVILLE
State	FL
ZIP	32208
Phone	904 503-2290
CertificateType	4
CertificateEffectiveDate	12/27/2023
CertificateExpirationDate	12/26/2025
FacilityType	Waiver

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