12D2163498 CLIA NUMBER - WAIANAE DIS COMP HLTH & HOSP BRD INC, SBHC-NHIS

Laboratory Demographics

CLIA Number: 12D2163498

Facility Name: WAIANAE DIS COMP HLTH & HOSP BRD INC, SBHC-NHIS

Facility Address:
89-980 NANAKULI AVENUE
WAIANAE, HI
ZIP 96792
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Facility Phone Number: 808 697-3222

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1366942831

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	12D2163498
LAB Type	School/Student Health Service
Facility Name	WAIANAE DIS COMP HLTH & HOSP BRD INC, SBHC-NHIS
Street	89-980 NANAKULI AVENUE
City	WAIANAE
State	HI
ZIP	96792
Phone	808 697-3222
CertificateType	4
CertificateEffectiveDate	3/14/2023
CertificateExpirationDate	3/13/2025
FacilityType	Waiver

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