22D2130546 CLIA NUMBER - ELDER SERVICE PLAN OF HARBOR HEALTH SE BROCKTON BROCKTON

Laboratory Demographics

  • CLIA Code: 22D2130546
  • Facility Name: ELDER SERVICE PLAN OF HARBOR HEALTH SE BROCKTON BROCKTON
  • Facility Address: 479 TORREY ST
    BROCKTON, MA
    ZIP 02301
  • Facility Phone: 617 533-2400
  • Facility Type: Other - PACE PROGRAM
  • Facility Type: Waiver
  • Lab Director: ILONA KOPITS
  • NPI Number: 1225064264
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 22D2130546
LAB Type Other - PACE PROGRAM
Facility Name ELDER SERVICE PLAN OF HARBOR HEALTH SE BROCKTON BROCKTON
Street 479 TORREY ST
City BROCKTON
State MA
ZIP 02301
Phone 617 533-2400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2025
Certificate Expiration Date 5/10/2027
Facility Type Other - PACE PROGRAM
Lab Director ILONA KOPITS

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