18D2269354 CLIA NUMBER - MOUNTAIN COMPREHENSIVE CARE CENTER - HOMEPLACE OB/GYN

Laboratory Demographics

CLIA Number: 18D2269354

Facility Name: MOUNTAIN COMPREHENSIVE CARE CENTER - HOMEPLACE OB/GYN

Facility Address:
22 HARBOR LANE
PRESTONSBURG, KY
ZIP 41653
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Facility Phone Number: 606 886-8572

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1184182180

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D2269354
LAB Type	Federally Qualified Health Center
Facility Name	MOUNTAIN COMPREHENSIVE CARE CENTER - HOMEPLACE OB/GYN
Street	22 HARBOR LANE
City	PRESTONSBURG
State	KY
ZIP	41653
Phone	606 886-8572
CertificateType	3
CertificateEffectiveDate	9/26/2022
CertificateExpirationDate	9/25/2024
FacilityType	PPMP

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