33D1059664 CLIA NUMBER - LA CASA DE SALUD INC

Laboratory Demographics

CLIA Number: 33D1059664

Facility Name: LA CASA DE SALUD INC

Facility Address:
966 PROSPECT AVE
BRONX, NY
ZIP 10459
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Facility Phone Number: 718 842-1412

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1548260870

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D1059664
LAB Type	Community Clinic
Facility Name	LA CASA DE SALUD INC
Street	966 PROSPECT AVE
City	BRONX
State	NY
ZIP	10459
Phone	718 842-1412
CertificateType	4
CertificateEffectiveDate	4/13/2009
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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