20D0906087 CLIA NUMBER - 75 STATE STREET

Laboratory Demographics

  • CLIA Code: 20D0906087
  • Facility Name: 75 STATE STREET
  • Facility Address: 75 STATE STREET
    PORTLAND, ME
    ZIP 04101
  • Facility Phone: 207 775-7775
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: SUSAN S. CURTIS
  • NPI Number: 1528201738
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 20D0906087
LAB Type Assisted Living Facility
Facility Name 75 STATE STREET
Street 75 STATE STREET
City PORTLAND
State ME
ZIP 04101
Phone 207 775-7775
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/28/2025
Certificate Expiration Date 9/27/2027
Facility Type Assisted Living Facility
Lab Director SUSAN S. CURTIS

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