29D1064794 CLIA NUMBER - LAS VEGAS URBAN LEAGUE WIC - WEST

Laboratory Demographics

CLIA Number: 29D1064794

Facility Name: LAS VEGAS URBAN LEAGUE WIC - WEST

Facility Address:
6480 W FLAMINGO STE B
LAS VEGAS, NV
ZIP 89103
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Facility Phone Number: 702 476-9561

Facility Type: Other - WIC

Certificate Type: Waiver

NPI Number: 1134639156

Taxonomy: 3747A0650X - Technician
An individual who provides hands-on care, of both a supportive and health related nature, specific to the needs of a medically stable, physically handicapped individual. Supportive services are those that substitute for the absence, loss, diminution, or impairment of a physical or cognitive function. This service may include skilled or nursing care to the extent permitted by state law.

CLIA Record

Field Name	Field Value
CLIA Number	29D1064794
LAB Type	Other - WIC
Facility Name	LAS VEGAS URBAN LEAGUE WIC - WEST
Street	6480 W FLAMINGO STE B
City	LAS VEGAS
State	NV
ZIP	89103
Phone	702 476-9561
CertificateType	4
CertificateEffectiveDate	2/13/2023
CertificateExpirationDate	2/12/2025
FacilityType	Waiver

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