36D1091674 CLIA NUMBER - VILLA OF GREAT NORTHERN

Laboratory Demographics

  • CLIA Code: 36D1091674
  • Facility Name: VILLA OF GREAT NORTHERN
  • Facility Address: 22710 FAIRVIEW CENTER DRIVE
    FAIRVIEW PARK, OH
    ZIP 44126
  • Facility Phone: 440 734-4630
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: ANCA VLASIE
  • NPI Number: 1659525590
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 36D1091674
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name VILLA OF GREAT NORTHERN
Street 22710 FAIRVIEW CENTER DRIVE
City FAIRVIEW PARK
State OH
ZIP 44126
Phone 440 734-4630
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2024
Certificate Expiration Date 11/5/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director ANCA VLASIE

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