10D2235364 CLIA NUMBER - ULTIMATE PREVENTIVE CARE GROUP INC

Laboratory Demographics

CLIA Number: 10D2235364

Facility Name: ULTIMATE PREVENTIVE CARE GROUP INC

Facility Address:
5632 NW 99TH WAY
CORAL SPRINGS, FL
ZIP 33076
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Facility Phone Number: 954 326-0613

Facility Type: Other - HOME VISITS

Certificate Type: Waiver

NPI Number: 1003423468

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2235364
LAB Type	Other - HOME VISITS
Facility Name	ULTIMATE PREVENTIVE CARE GROUP INC
Street	5632 NW 99TH WAY
City	CORAL SPRINGS
State	FL
ZIP	33076
Phone	954 326-0613
CertificateType	4
CertificateEffectiveDate	9/8/2023
CertificateExpirationDate	9/7/2025
FacilityType	Waiver

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