20D0924102 CLIA NUMBER - UPLIFT INC - PUTNAM DRIVE

Laboratory Demographics

CLIA Code: 20D0924102
Facility Name: UPLIFT INC - PUTNAM DRIVE
Facility Address: PO BOX 1106
GARDINER, ME
ZIP 04345
Facility Phone: 207 622-6712
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: BERNIECE MANSIR
NPI Number: 1063473866
Taxonomy: 320900000X - Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	20D0924102
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	UPLIFT INC - PUTNAM DRIVE
Street	PO BOX 1106
City	GARDINER
State	ME
ZIP	04345
Phone	207 622-6712
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	1/21/2025
Certificate Expiration Date	1/20/2027
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	BERNIECE MANSIR

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