23D2228672 CLIA NUMBER - DEDICATED SENIOR MEDICAL CENTER - EASTPOINTE

Laboratory Demographics

CLIA Number: 23D2228672

Facility Name: DEDICATED SENIOR MEDICAL CENTER - EASTPOINTE

Facility Address:
21811 KELLY ROAD
EASTPOINTE, MI
ZIP 48021
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Facility Phone Number: 305 842-3910

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1730754656

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	23D2228672
LAB Type	Physician Office
Facility Name	DEDICATED SENIOR MEDICAL CENTER - EASTPOINTE
Street	21811 KELLY ROAD
City	EASTPOINTE
State	MI
ZIP	48021
Phone	305 842-3910
CertificateType	4
CertificateEffectiveDate	6/29/2023
CertificateExpirationDate	6/28/2025
FacilityType	Waiver

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