22D2301515 CLIA NUMBER - PROVIDENCE TREATMENT

Laboratory Demographics

  • CLIA Code: 22D2301515
  • Facility Name: PROVIDENCE TREATMENT
  • Facility Address: 896 BEACON ST STE A
    BOSTON, MA
    ZIP 02215
  • Facility Phone: 312 342-5304
  • Facility Type: Other - OUTPATIENT OFFICE
  • Facility Type: Waiver
  • Lab Director: GABE LAU
  • NPI Number: 1942920459
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 22D2301515
LAB Type Other - OUTPATIENT OFFICE
Facility Name PROVIDENCE TREATMENT
Street 896 BEACON ST STE A
City BOSTON
State MA
ZIP 02215
Phone 312 342-5304
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/27/2024
Certificate Expiration Date 3/26/2026
Facility Type Other - OUTPATIENT OFFICE
Lab Director GABE LAU

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