36D2186615 CLIA NUMBER - THE MODE - MIRACLES OCCUR DAYS ENRICHED

Laboratory Demographics

CLIA Number: 36D2186615

Facility Name: THE MODE - MIRACLES OCCUR DAYS ENRICHED

Facility Address:
50 BAKER BLVD, SUITE 5A
FAIRLAWN, OH
ZIP 44333
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Facility Phone Number: 330 388-5757

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1083232102

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D2186615
LAB Type	Practitioner Other
Facility Name	THE MODE - MIRACLES OCCUR DAYS ENRICHED
Street	50 BAKER BLVD, SUITE 5A
City	FAIRLAWN
State	OH
ZIP	44333
Phone	330 388-5757
CertificateType	4
CertificateEffectiveDate	6/19/2022
CertificateExpirationDate	6/18/2024
FacilityType	Waiver

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