22D2112381 CLIA NUMBER - DODGE PARK REST HOME

Laboratory Demographics

  • CLIA Code: 22D2112381
  • Facility Name: DODGE PARK REST HOME
  • Facility Address: 101 RANDOLPH RD
    WORCESTER, MA
    ZIP 01606
  • Facility Phone: 508 853-8180
  • Facility Type: Other - REST HOME
  • Facility Type: Waiver
  • Lab Director: MICHA SHALEV
  • NPI Number: 1154464584
  • Taxonomy: 261QC1800X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 22D2112381
LAB Type Other - REST HOME
Facility Name DODGE PARK REST HOME
Street 101 RANDOLPH RD
City WORCESTER
State MA
ZIP 01606
Phone 508 853-8180
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type Other - REST HOME
Lab Director MICHA SHALEV

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