36D2045025 CLIA NUMBER - NATIONAL CHURCH RESIDENCES MEDICAL HOME

Laboratory Demographics

  • CLIA Code: 36D2045025
  • Facility Name: NATIONAL CHURCH RESIDENCES MEDICAL HOME
  • Facility Address: 1280 NORTON AVE
    COLUMBUS, OH
    ZIP 43212
  • Facility Phone: 614 484-0797
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ANDREA SHIELDS
  • NPI Number: 1871007062
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 36D2045025
LAB Type Practitioner Other
Facility Name NATIONAL CHURCH RESIDENCES MEDICAL HOME
Street 1280 NORTON AVE
City COLUMBUS
State OH
ZIP 43212
Phone 614 484-0797
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/6/2024
Certificate Expiration Date 8/5/2026
Facility Type Practitioner Other
Lab Director ANDREA SHIELDS

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