23D2078996 CLIA NUMBER - HENRY FORD HOSPITAL - WEST BLOOMFIELD

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Laboratory Demographics

CLIA Number: 23D2078996

Facility Name: HENRY FORD HOSPITAL - WEST BLOOMFIELD

Facility Address:
6777 W MAPLE ROAD 2ND FLOOR EAST ROOM 2040
WEST BLOOMFIELD, MI
ZIP 48322
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Facility Phone Number: 248 325-2452

Facility Type: Other - OUTPATIENT CLINIC

Certificate Type: Waiver

NPI Number: 1790170777

Taxonomy: 261QC1500X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D2078996
LAB Type	Other - OUTPATIENT CLINIC
Facility Name	HENRY FORD HOSPITAL - WEST BLOOMFIELD
Street	6777 W MAPLE ROAD 2ND FLOOR EAST ROOM 2040
City	WEST BLOOMFIELD
State	MI
ZIP	48322
Phone	248 325-2452
CertificateType	4
CertificateEffectiveDate	6/9/2022
CertificateExpirationDate	6/8/2024
FacilityType	Waiver

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