36D2161020 CLIA NUMBER - LAKE EFFECT HEALTH LLC

Laboratory Demographics

  • CLIA Code: 36D2161020
  • Facility Name: LAKE EFFECT HEALTH LLC
  • Facility Address: 3611 PROSPECT AVENUE E
    CLEVELAND, OH
    ZIP 44115
  • Facility Phone: 216 205-4862
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: SEANA RUTHERFORD
  • NPI Number: 1780156984
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 36D2161020
LAB Type Practitioner Other
Facility Name LAKE EFFECT HEALTH LLC
Street 3611 PROSPECT AVENUE E
City CLEVELAND
State OH
ZIP 44115
Phone 216 205-4862
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/24/2025
Certificate Expiration Date 1/23/2027
Facility Type Practitioner Other
Lab Director SEANA RUTHERFORD

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