34D2076755 CLIA NUMBER - EMMANUEL HOME LLC, THE

Laboratory Demographics

CLIA Code: 34D2076755
Facility Name: EMMANUEL HOME LLC, THE
Facility Address: 5212 SWEETBRIAR DRIVE
RALEIGH, NC
ZIP 27609
Facility Phone: 919 231-2981
Facility Type: Other - GROUP HOME
Facility Type: Waiver
Lab Director: ELISE DOWTIN
NPI Number: 1639213846
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	34D2076755
LAB Type	Other - GROUP HOME
Facility Name	EMMANUEL HOME LLC, THE
Street	5212 SWEETBRIAR DRIVE
City	RALEIGH
State	NC
ZIP	27609
Phone	919 231-2981
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	4/25/2024
Certificate Expiration Date	4/24/2026
Facility Type	Other - GROUP HOME
Lab Director	ELISE DOWTIN

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This page was last updated on: 3/20/2025