22D2246752 CLIA NUMBER - PROVIDENCE HOUSE ASSISTED LIVING

Laboratory Demographics

  • CLIA Code: 22D2246752
  • Facility Name: PROVIDENCE HOUSE ASSISTED LIVING
  • Facility Address: 180 COREY RD
    BRIGHTON, MA
    ZIP 02135
  • Facility Phone: 617 731-0505
  • Facility Type: Assisted Living Facility
  • Facility Type: Waiver
  • Lab Director: CHARLES JAMES
  • NPI Number: 1225162415
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 22D2246752
LAB Type Assisted Living Facility
Facility Name PROVIDENCE HOUSE ASSISTED LIVING
Street 180 COREY RD
City BRIGHTON
State MA
ZIP 02135
Phone 617 731-0505
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/29/2023
Certificate Expiration Date 12/28/2025
Facility Type Assisted Living Facility
Lab Director CHARLES JAMES

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