36D2130764 CLIA NUMBER - COLEMAN PROFESSIONAL SERVICES

Laboratory Demographics

CLIA Number: 36D2130764

Facility Name: COLEMAN PROFESSIONAL SERVICES

Facility Address:
1410 W STATE STREET
ALLIANCE, OH
ZIP 44601
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Facility Phone Number: 330 673-1347

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1215230669

Taxonomy: 101YM0800X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	36D2130764
LAB Type	Community Clinic
Facility Name	COLEMAN PROFESSIONAL SERVICES
Street	1410 W STATE STREET
City	ALLIANCE
State	OH
ZIP	44601
Phone	330 673-1347
CertificateType	4
CertificateEffectiveDate	5/17/2023
CertificateExpirationDate	5/16/2025
FacilityType	Waiver

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