33D0723844 CLIA NUMBER - WELLNESS CENTER OPERATED BY PREMISE HEALTH, THE

Laboratory Demographics

CLIA Number: 33D0723844

Facility Name: WELLNESS CENTER OPERATED BY PREMISE HEALTH, THE

Facility Address:
497 ELECTRONIC PARKWAY
LIVERPOOL, NY
ZIP 13088
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Facility Phone Number: 315 456-3133

Facility Type: Industrial

Certificate Type: Waiver

NPI Number: 1427446301

Taxonomy: 101YP2500X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	33D0723844
LAB Type	Industrial
Facility Name	WELLNESS CENTER OPERATED BY PREMISE HEALTH, THE
Street	497 ELECTRONIC PARKWAY
City	LIVERPOOL
State	NY
ZIP	13088
Phone	315 456-3133
CertificateType	4
CertificateEffectiveDate	12/10/1998
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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