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

Laboratory Demographics

  • CLIA Code: 36D2186615
  • Facility Name: THE MODE - MIRACLES OCCUR DAYS ENRICHED
  • Facility Address: 50 BAKER BLVD, SUITE 5A
    FAIRLAWN, OH
    ZIP 44333
  • Facility Phone: 330 388-5757
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: LISA L. PETRARCA-GAMIDO
  • NPI Number: 1083232102
  • Taxonomy: 261QR0405X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/19/2024
Certificate Expiration Date 6/18/2026
Facility Type Practitioner Other
Lab Director LISA L. PETRARCA-GAMIDO

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This page was last updated on: 6/4/2025