23D0988683 CLIA NUMBER - COREWELL HEALTH GRH ENDOSCOPY - 4100 LAKE DR

Laboratory Demographics

CLIA Number: 23D0988683

Facility Name: COREWELL HEALTH GRH ENDOSCOPY - 4100 LAKE DR

Facility Address:
4100 LAKE DRIVE SUITE 105
KENTWOOD, MI
ZIP 49546
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Facility Phone Number: 616 391-7580

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1366438632

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D0988683
LAB Type	Ambulatory Surgery Center
Facility Name	COREWELL HEALTH GRH ENDOSCOPY - 4100 LAKE DR
Street	4100 LAKE DRIVE SUITE 105
City	KENTWOOD
State	MI
ZIP	49546
Phone	616 391-7580
CertificateType	4
CertificateEffectiveDate	7/5/2023
CertificateExpirationDate	7/4/2025
FacilityType	Waiver

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