23D0955024 CLIA NUMBER - EXALTA HEALTH

Laboratory Demographics

  • CLIA Code: 23D0955024
  • Facility Name: EXALTA HEALTH
  • Facility Address: 2060 DIVISION AVENUE S
    GRAND RAPIDS, MI
    ZIP 49507
  • Facility Phone: 616 475-8446
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: LAURA A. VANDER MOLEN
  • NPI Number: 1588840854
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 23D0955024
LAB Type Community Clinic
Facility Name EXALTA HEALTH
Street 2060 DIVISION AVENUE S
City GRAND RAPIDS
State MI
ZIP 49507
Phone 616 475-8446
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 12/16/2024
Certificate Expiration Date 12/15/2026
Facility Type Community Clinic
Lab Director LAURA A. VANDER MOLEN

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