10D2221198 CLIA NUMBER - GREEN HEALTH SERVICES LLC

Laboratory Demographics

CLIA Number: 10D2221198

Facility Name: GREEN HEALTH SERVICES LLC

Facility Address:
5401 S KIRKMAN RD STE 310
ORLANDO, FL
ZIP 32819
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Facility Phone Number: 407 759-3311

Facility Type: Other - NURSE PRACTIONER

Certificate Type: Waiver

NPI Number: 1598361677

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	10D2221198
LAB Type	Other - NURSE PRACTIONER
Facility Name	GREEN HEALTH SERVICES LLC
Street	5401 S KIRKMAN RD STE 310
City	ORLANDO
State	FL
ZIP	32819
Phone	407 759-3311
CertificateType	4
CertificateEffectiveDate	4/20/2023
CertificateExpirationDate	4/19/2025
FacilityType	Waiver

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