23D2091927 CLIA NUMBER - ST JOHN WARREN MOTT HIGH SCHOOL-BASED HEALTH CTR

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Laboratory Demographics

CLIA Number: 23D2091927

Facility Name: ST JOHN WARREN MOTT HIGH SCHOOL-BASED HEALTH CTR

Facility Address:
3131 E 12 MILE ROAD
WARREN, MI
ZIP 48092
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Facility Phone Number: 248 849-5692

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1780716449

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	23D2091927
LAB Type	School/Student Health Service
Facility Name	ST JOHN WARREN MOTT HIGH SCHOOL-BASED HEALTH CTR
Street	3131 E 12 MILE ROAD
City	WARREN
State	MI
ZIP	48092
Phone	248 849-5692
CertificateType	4
CertificateEffectiveDate	2/23/2023
CertificateExpirationDate	2/22/2025
FacilityType	Waiver

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