36D2005329 CLIA NUMBER - AUSTINTOWN MEDICAL OFFICE BUILDING

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Laboratory Demographics

CLIA Number: 36D2005329

Facility Name: AUSTINTOWN MEDICAL OFFICE BUILDING

Facility Address:
5533 MAHONING AVENUE SECOND FLOOR
AUSTINTOWN, OH
ZIP 44515
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Facility Phone Number: 330 793-2701

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1689048233

Taxonomy: 310400000X - Assisted Living Facility
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

CLIA Record

Field Name	Field Value
CLIA Number	36D2005329
LAB Type	Physician Office
Facility Name	AUSTINTOWN MEDICAL OFFICE BUILDING
Street	5533 MAHONING AVENUE SECOND FLOOR
City	AUSTINTOWN
State	OH
ZIP	44515
Phone	330 793-2701
CertificateType	4
CertificateEffectiveDate	3/25/2024
CertificateExpirationDate	3/24/2026
FacilityType	Waiver

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