34D2112395 CLIA NUMBER - INTENTIONAL LONGEVITY, INC DBA CENTER FOR SPIRITUAL EMERGENCE

Laboratory Demographics

  • CLIA Code: 34D2112395
  • Facility Name: INTENTIONAL LONGEVITY, INC DBA CENTER FOR SPIRITUAL EMERGENCE
  • Facility Address: 370 NORTH LOUISIANA AVENUE, SUITES D3 AND D4
    ASHEVILLE, NC
    ZIP 28806
  • Facility Phone: 828 273-1643
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: GRADY B. JEFFERYS JR
  • NPI Number: 1093174088
  • Taxonomy: 261QM0850X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 34D2112395
LAB Type Comp. Outpatient Rehab Facility
Facility Name INTENTIONAL LONGEVITY, INC DBA CENTER FOR SPIRITUAL EMERGENCE
Street 370 NORTH LOUISIANA AVENUE, SUITES D3 AND D4
City ASHEVILLE
State NC
ZIP 28806
Phone 828 273-1643
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type Comp. Outpatient Rehab Facility
Lab Director GRADY B. JEFFERYS JR

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