31D2326380 CLIA NUMBER - GRACE BEHAVIORAL HEALTH SERVICES, PC

Laboratory Demographics

  • CLIA Code: 31D2326380
  • Facility Name: GRACE BEHAVIORAL HEALTH SERVICES, PC
  • Facility Address: 1140 BURNT TAVERN ROAD STE 1A
    BRICK, NJ
    ZIP 08724
  • Facility Phone: 732 475-9881
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: OMEZIE MOLOKWU
  • NPI Number: 1437766375
  • Taxonomy: 363LP0808X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 31D2326380
LAB Type Practitioner Other
Facility Name GRACE BEHAVIORAL HEALTH SERVICES, PC
Street 1140 BURNT TAVERN ROAD STE 1A
City BRICK
State NJ
ZIP 08724
Phone 732 475-9881
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/2/2025
Certificate Expiration Date 7/1/2027
Facility Type Practitioner Other
Lab Director OMEZIE MOLOKWU

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