36D2201142 CLIA NUMBER - BITTERSWEET FARMS

Laboratory Demographics

CLIA Code: 36D2201142
Facility Name: BITTERSWEET FARMS
Facility Address: 12660 ARCHBOLD-WHITEHOUSE ROAD
WHITEHOUSE, OH
ZIP 43571
Facility Phone: 419 875-6986
Facility Type: Intermediate Care Facility for Mentally Retarded
Facility Type: Waiver
Lab Director: AMY LAWRENCE
NPI Number: 1104900885
Taxonomy: 320600000X - Residential Treatment Facility, Intellectual and/or Developmental Disabilities

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CLIA Record

Field Name	Field Value
CLIA Number	36D2201142
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	BITTERSWEET FARMS
Street	12660 ARCHBOLD-WHITEHOUSE ROAD
City	WHITEHOUSE
State	OH
ZIP	43571
Phone	419 875-6986
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	11/19/2024
Certificate Expiration Date	11/18/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	AMY LAWRENCE

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