23D2217635 CLIA NUMBER - RESTORATION HEALTH LLC

Laboratory Demographics

CLIA Number: 23D2217635

Facility Name: RESTORATION HEALTH LLC

Facility Address:
17731 E WARREN SUITE 1
DETROIT, MI
ZIP 48224
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Facility Phone Number: 734 489-9863

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1962955625

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	23D2217635
LAB Type	Physician Office
Facility Name	RESTORATION HEALTH LLC
Street	17731 E WARREN SUITE 1
City	DETROIT
State	MI
ZIP	48224
Phone	734 489-9863
CertificateType	4
CertificateEffectiveDate	3/23/2023
CertificateExpirationDate	3/22/2025
FacilityType	Waiver

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