36D2115041 CLIA NUMBER - VITALITY HEALTH, LLC

Laboratory Demographics

CLIA Number: 36D2115041

Facility Name: VITALITY HEALTH, LLC

Facility Address:
34970 DETROIT ROAD SUITE 106
AVON, OH
ZIP 44011
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Facility Phone Number: 440 250-0822

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1184283962

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D2115041
LAB Type	Physician Office
Facility Name	VITALITY HEALTH, LLC
Street	34970 DETROIT ROAD SUITE 106
City	AVON
State	OH
ZIP	44011
Phone	440 250-0822
CertificateType	4
CertificateEffectiveDate	6/27/2022
CertificateExpirationDate	6/26/2024
FacilityType	Waiver

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