34D2183138 CLIA NUMBER - ESSENTIAL HEALTH & WELLNESS RALEIGH

Laboratory Demographics

CLIA Number: 34D2183138

Facility Name: ESSENTIAL HEALTH & WELLNESS RALEIGH

Facility Address:
2011 FALLS VALLEY DRIVE, SUITE 100
RALEIGH, NC
ZIP 27615
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Facility Phone Number: 919 208-2314

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1003326802

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D2183138
LAB Type	Physician Office
Facility Name	ESSENTIAL HEALTH & WELLNESS RALEIGH
Street	2011 FALLS VALLEY DRIVE, SUITE 100
City	RALEIGH
State	NC
ZIP	27615
Phone	919 208-2314
CertificateType	4
CertificateEffectiveDate	4/30/2024
CertificateExpirationDate	4/29/2026
FacilityType	Waiver

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