18D2228614 CLIA NUMBER - GRACE COMMUNITY HEALTH CENTER UC CLINIC

Laboratory Demographics

CLIA Number: 18D2228614

Facility Name: GRACE COMMUNITY HEALTH CENTER UC CLINIC

Facility Address:
49 WEST SYCAMORE ST
WILLIAMSBURG, KY
ZIP 40769
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Facility Phone Number: 606 400-6326

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1134798499

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D2228614
LAB Type	Federally Qualified Health Center
Facility Name	GRACE COMMUNITY HEALTH CENTER UC CLINIC
Street	49 WEST SYCAMORE ST
City	WILLIAMSBURG
State	KY
ZIP	40769
Phone	606 400-6326
CertificateType	4
CertificateEffectiveDate	6/29/2023
CertificateExpirationDate	6/28/2025
FacilityType	Waiver

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