36D2161610 CLIA NUMBER - WINGSPAN CARE GROUP

Laboratory Demographics

  • CLIA Code: 36D2161610
  • Facility Name: WINGSPAN CARE GROUP
  • Facility Address: 22001 FAIRMOUNT BOULEVARD
    SHAKER HEIGHTS, OH
    ZIP 44118
  • Facility Phone: 216 320-8308
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ADAM G. JACOBS
  • NPI Number: 1366913808
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 36D2161610
LAB Type Physician Office
Facility Name WINGSPAN CARE GROUP
Street 22001 FAIRMOUNT BOULEVARD
City SHAKER HEIGHTS
State OH
ZIP 44118
Phone 216 320-8308
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2025
Certificate Expiration Date 2/5/2027
Facility Type Physician Office
Lab Director ADAM G. JACOBS

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