20D2214066 CLIA NUMBER - LOCAL ROOTS HEALTH CARE, PLLC

Laboratory Demographics

CLIA Number: 20D2214066

Facility Name: LOCAL ROOTS HEALTH CARE, PLLC

Facility Address:
12 DEPOT STREET
KENNEBUNK, ME
ZIP 04043
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Facility Phone Number: 207 929-0170

Facility Type: Other - PRIMARY CARE CLINIC

Certificate Type: Waiver

NPI Number: 1609468347

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	20D2214066
LAB Type	Other - PRIMARY CARE CLINIC
Facility Name	LOCAL ROOTS HEALTH CARE, PLLC
Street	12 DEPOT STREET
City	KENNEBUNK
State	ME
ZIP	04043
Phone	207 929-0170
CertificateType	4
CertificateEffectiveDate	2/18/2023
CertificateExpirationDate	2/17/2025
FacilityType	Waiver

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