18D2257566 CLIA NUMBER - MOUNTAIN COMPREHENSIVE CARE CENTER - HOMEPLACE CLINIC

Laboratory Demographics

CLIA Number: 18D2257566

Facility Name: MOUNTAIN COMPREHENSIVE CARE CENTER - HOMEPLACE CLINIC

Facility Address:
2222 WINCHESTER AVE
ASHLAND, KY
ZIP 41101
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Facility Phone Number: 606 886-8572

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1699386078

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D2257566
LAB Type	Federally Qualified Health Center
Facility Name	MOUNTAIN COMPREHENSIVE CARE CENTER - HOMEPLACE CLINIC
Street	2222 WINCHESTER AVE
City	ASHLAND
State	KY
ZIP	41101
Phone	606 886-8572
CertificateType	4
CertificateEffectiveDate	4/7/2024
CertificateExpirationDate	4/6/2026
FacilityType	Waiver

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