21D2255133 CLIA NUMBER - TIDALHEALTH

Laboratory Demographics

CLIA Number: 21D2255133

Facility Name: TIDALHEALTH

Facility Address:
200 EAST VINE STREET
SALISBURY, MD
ZIP 21804
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Facility Phone Number: 410 543-7181

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1912473265

Taxonomy: 261QM0850X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.

CLIA Record

Field Name	Field Value
CLIA Number	21D2255133
LAB Type	Community Clinic
Facility Name	TIDALHEALTH
Street	200 EAST VINE STREET
City	SALISBURY
State	MD
ZIP	21804
Phone	410 543-7181
CertificateType	4
CertificateEffectiveDate	3/10/2024
CertificateExpirationDate	3/9/2026
FacilityType	Waiver

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