36D2151785 CLIA NUMBER - PROUD TO BE, INC

Laboratory Demographics

  • CLIA Code: 36D2151785
  • Facility Name: PROUD TO BE, INC
  • Facility Address: 11811 SHAKER BLVD SUITE #123
    CLEVELAND, OH
    ZIP 44120
  • Facility Phone: 216 242-2990
  • Facility Type: Other - PSYCHIATRIC & ADDICTION
  • Facility Type: Waiver
  • Lab Director: TIFFANY M. MARTIN-THORNTON
  • NPI Number: 1376050542
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 36D2151785
LAB Type Other - PSYCHIATRIC & ADDICTION
Facility Name PROUD TO BE, INC
Street 11811 SHAKER BLVD SUITE #123
City CLEVELAND
State OH
ZIP 44120
Phone 216 242-2990
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/27/2024
Certificate Expiration Date 7/26/2026
Facility Type Other - PSYCHIATRIC & ADDICTION
Lab Director TIFFANY M. MARTIN-THORNTON

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