23D0941238 CLIA NUMBER - BAXTER COMMUNITY CENTER WHOLISTIC HEALTH CLINIC

Laboratory Demographics

  • CLIA Code: 23D0941238
  • Facility Name: BAXTER COMMUNITY CENTER WHOLISTIC HEALTH CLINIC
  • Facility Address: 935 BAXTER STREET SE
    GRAND RAPIDS, MI
    ZIP 49506
  • Facility Phone: 616 456-5310
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: RICHARD A. VAN DYKEN
  • NPI Number: 1164625109
  • Taxonomy: 251K00000X - Public Health or Welfare

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CLIA Record

Field Name Field Value
CLIA Number 23D0941238
LAB Type Community Clinic
Facility Name BAXTER COMMUNITY CENTER WHOLISTIC HEALTH CLINIC
Street 935 BAXTER STREET SE
City GRAND RAPIDS
State MI
ZIP 49506
Phone 616 456-5310
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/23/2024
Certificate Expiration Date 2/22/2026
Facility Type Community Clinic
Lab Director RICHARD A. VAN DYKEN

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