15D2115688 CLIA NUMBER - 219 HEALTH NETWORK, INC

Laboratory Demographics

CLIA Number: 15D2115688

Facility Name: 219 HEALTH NETWORK, INC

Facility Address:
9126 COLUMBIA AVENUE
MUNSTER, IN
ZIP 46321
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Facility Phone Number: 219 703-2408

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1861125932

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D2115688
LAB Type	Physician Office
Facility Name	219 HEALTH NETWORK, INC
Street	9126 COLUMBIA AVENUE
City	MUNSTER
State	IN
ZIP	46321
Phone	219 703-2408
CertificateType	4
CertificateEffectiveDate	7/12/2022
CertificateExpirationDate	7/11/2024
FacilityType	Waiver

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