10D2313501 CLIA NUMBER - PROVIDIA HOME CARE, LLC

Laboratory Demographics

  • CLIA Code: 10D2313501
  • Facility Name: PROVIDIA HOME CARE, LLC
  • Facility Address: 3661 CORTEZ RD W - SUITE 100
    BRADENTON, FL
    ZIP 34210
  • Facility Phone: 813 540-3300
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: CHRISTOPHER A. MELLEY
  • NPI Number: 1932935459
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 10D2313501
LAB Type Home Health Agency
Facility Name PROVIDIA HOME CARE, LLC
Street 3661 CORTEZ RD W - SUITE 100
City BRADENTON
State FL
ZIP 34210
Phone 813 540-3300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2024
Certificate Expiration Date 10/31/2026
Facility Type Home Health Agency
Lab Director CHRISTOPHER A. MELLEY

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