10D2220686 CLIA NUMBER - GREENLIFE INTENSIVE OUTPATIENT PROGRAM LLC

Laboratory Demographics

  • CLIA Code: 10D2220686
  • Facility Name: GREENLIFE INTENSIVE OUTPATIENT PROGRAM LLC
  • Facility Address: 1601 N PALM AVE STE 106
    PEMBROKE PINES, FL
    ZIP 33026
  • Facility Phone: 954 968-9100
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ZVI A. ITZCHAKI
  • NPI Number: 1740638717
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2220686
LAB Type Practitioner Other
Facility Name GREENLIFE INTENSIVE OUTPATIENT PROGRAM LLC
Street 1601 N PALM AVE STE 106
City PEMBROKE PINES
State FL
ZIP 33026
Phone 954 968-9100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/14/2025
Certificate Expiration Date 4/13/2027
Facility Type Practitioner Other
Lab Director ZVI A. ITZCHAKI

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