23D0959661 CLIA NUMBER - BLUE WATER CHILDREN'S HEALTH CARE

Laboratory Demographics

CLIA Number: 23D0959661

Facility Name: BLUE WATER CHILDREN'S HEALTH CARE

Facility Address:
105 COMMERCE DRIVE
YALE, MI
ZIP 48097
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Facility Phone Number: 810 387-9612

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1467590406

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D0959661
LAB Type	Physician Office
Facility Name	BLUE WATER CHILDREN'S HEALTH CARE
Street	105 COMMERCE DRIVE
City	YALE
State	MI
ZIP	48097
Phone	810 387-9612
CertificateType	4
CertificateEffectiveDate	4/16/2023
CertificateExpirationDate	4/15/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024