18D2289198 CLIA NUMBER - LIFE COORDINATED COMMONWEALTH PACE

Laboratory Demographics

  • CLIA Code: 18D2289198
  • Facility Name: LIFE COORDINATED COMMONWEALTH PACE
  • Facility Address: 201 E 11TH STREET
    BENTON, KY
    ZIP 42025
  • Facility Phone: 855 209-5451
  • Facility Type: Other - PACE CENTER
  • Facility Type: Waiver
  • Lab Director: DR. WAYNE O. WELLS
  • NPI Number: 1447994009
  • Taxonomy: 251B00000X - Case Management

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CLIA Record

Field Name Field Value
CLIA Number 18D2289198
LAB Type Other - PACE CENTER
Facility Name LIFE COORDINATED COMMONWEALTH PACE
Street 201 E 11TH STREET
City BENTON
State KY
ZIP 42025
Phone 855 209-5451
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/7/2025
Certificate Expiration Date 9/6/2027
Facility Type Other - PACE CENTER
Lab Director DR. WAYNE O. WELLS

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This page was last updated on: 9/29/2025