36D0678215 CLIA NUMBER - PROVIDENCE CARE CENTER

Laboratory Demographics

  • CLIA Code: 36D0678215
  • Facility Name: PROVIDENCE CARE CENTER
  • Facility Address: 2025 HAYES AVENUE
    SANDUSKY, OH
    ZIP 44870
  • Facility Phone: 419 627-2273
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: AMIE GOHLIKE ADM
  • NPI Number: 1730541905
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 36D0678215
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name PROVIDENCE CARE CENTER
Street 2025 HAYES AVENUE
City SANDUSKY
State OH
ZIP 44870
Phone 419 627-2273
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director AMIE GOHLIKE ADM

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