20D2175351 CLIA NUMBER - COASTAL MAINE DIRECT CARE, LLC

Laboratory Demographics

CLIA Number: 20D2175351

Facility Name: COASTAL MAINE DIRECT CARE, LLC

Facility Address:
74 LUNT ROAD
FALMOUTH, ME
ZIP 04105
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Facility Phone Number: 207 506-0301

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1104910926

Taxonomy: 213ES0103X - Podiatrist

CLIA Record

Field Name	Field Value
CLIA Number	20D2175351
LAB Type	Physician Office
Facility Name	COASTAL MAINE DIRECT CARE, LLC
Street	74 LUNT ROAD
City	FALMOUTH
State	ME
ZIP	04105
Phone	207 506-0301
CertificateType	4
CertificateEffectiveDate	11/20/2023
CertificateExpirationDate	11/19/2025
FacilityType	Waiver

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