36D2012287 CLIA NUMBER - SOUTHERN LOCAL SCHOOLS WELLNESS CENTER WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC

Laboratory Demographics

  • CLIA Code: 36D2012287
  • Facility Name: SOUTHERN LOCAL SCHOOLS WELLNESS CENTER WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
  • Facility Address: 906 ELM STREET
    RACINE, OH
    ZIP 45771
  • Facility Phone: 740 949-2348
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: SIREESHA DASARI
  • NPI Number: 1851536205
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 36D2012287
LAB Type Federally Qualified Health Center
Facility Name SOUTHERN LOCAL SCHOOLS WELLNESS CENTER WIRT COUNTY HEALTH SERVICES ASSOCIATION, INC
Street 906 ELM STREET
City RACINE
State OH
ZIP 45771
Phone 740 949-2348
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 Federally Qualified Health Center
Lab Director SIREESHA DASARI

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