23D2206918 CLIA NUMBER - GRATIOT COUNTY JAIL

Laboratory Demographics

  • CLIA Code: 23D2206918
  • Facility Name: GRATIOT COUNTY JAIL
  • Facility Address: 226 EAST CENTER ST
    ITHACA, MI
    ZIP 48847
  • Facility Phone: 989 640-4449
  • Facility Type: Other - COUNTY JAIL
  • Facility Type: Waiver
  • Lab Director: SHAUN M. MOON
  • NPI Number: 1376971671
  • Taxonomy: 253Z00000X - In Home Supportive Care

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CLIA Record

Field Name Field Value
CLIA Number 23D2206918
LAB Type Other - COUNTY JAIL
Facility Name GRATIOT COUNTY JAIL
Street 226 EAST CENTER ST
City ITHACA
State MI
ZIP 48847
Phone 989 640-4449
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/23/2024
Certificate Expiration Date 12/22/2026
Facility Type Other - COUNTY JAIL
Lab Director SHAUN M. MOON

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