36D2188015 CLIA NUMBER - DEDICATED SENIOR MEDICAL CENTER COLINWOOD

Laboratory Demographics

CLIA Number: 36D2188015

Facility Name: DEDICATED SENIOR MEDICAL CENTER COLINWOOD

Facility Address:
15105 ST CLAIR AVE
CLEVELAND, OH
ZIP 44110
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Facility Phone Number: 305 842-3910

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1023641867

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	36D2188015
LAB Type	Physician Office
Facility Name	DEDICATED SENIOR MEDICAL CENTER COLINWOOD
Street	15105 ST CLAIR AVE
City	CLEVELAND
State	OH
ZIP	44110
Phone	305 842-3910
CertificateType	4
CertificateEffectiveDate	7/10/2022
CertificateExpirationDate	7/9/2024
FacilityType	Waiver

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