20D0709006 CLIA NUMBER - PCHC DBA JACKMAN COMMUNITY HEALTH CENTER

Laboratory Demographics

CLIA Number: 20D0709006

Facility Name: PCHC DBA JACKMAN COMMUNITY HEALTH CENTER

Facility Address:
376 MAIN ST
JACKMAN, ME
ZIP 04945
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Facility Phone Number: 207 668-7755

Facility Type: Federally Qualified Health Center

Certificate Type: Certificate of Compliance

NPI Number: 1669802849

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	20D0709006
LAB Type	Federally Qualified Health Center
Facility Name	PCHC DBA JACKMAN COMMUNITY HEALTH CENTER
Street	376 MAIN ST
City	JACKMAN
State	ME
ZIP	04945
Phone	207 668-7755
CertificateType	2
CertificateEffectiveDate	12/5/2022
CertificateExpirationDate	12/4/2024
FacilityType	Compliance

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