10D2246205 CLIA NUMBER - UNIVERSAL MENTAL HEALTH INC DBA VIDA MEDICAL CENTERS

Laboratory Demographics

CLIA Number: 10D2246205

Facility Name: UNIVERSAL MENTAL HEALTH INC DBA VIDA MEDICAL CENTERS

Facility Address:
139 N REDLAND ROAD #5
HOMESTEAD, FL
ZIP 33034
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Facility Phone Number: 786 628-8656

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1740865039

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2246205
LAB Type	Physician Office
Facility Name	UNIVERSAL MENTAL HEALTH INC DBA VIDA MEDICAL CENTERS
Street	139 N REDLAND ROAD #5
City	HOMESTEAD
State	FL
ZIP	33034
Phone	786 628-8656
CertificateType	4
CertificateEffectiveDate	12/21/2023
CertificateExpirationDate	12/20/2025
FacilityType	Waiver

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