31D0653074 CLIA NUMBER - COOPER RIVER WEST

Laboratory Demographics

  • CLIA Code: 31D0653074
  • Facility Name: COOPER RIVER WEST
  • Facility Address: 5101 NORTH PARK DRIVE
    PENNSAUKEN, NJ
    ZIP 08109
  • Facility Phone: 609 665-8844
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: EDWARD TILTON
  • NPI Number: 1063656338
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 31D0653074
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name COOPER RIVER WEST
Street 5101 NORTH PARK DRIVE
City PENNSAUKEN
State NJ
ZIP 08109
Phone 609 665-8844
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director EDWARD TILTON

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