36D2254106 CLIA NUMBER - EMILY PROGRAM COLUMBUS OUTPATIENT

Laboratory Demographics

CLIA Number: 36D2254106

Facility Name: EMILY PROGRAM COLUMBUS OUTPATIENT

Facility Address:
8001 RAVINES EDGE CT #301
COLUMBUS, OH
ZIP 43235
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Facility Phone Number: 888 364-5977

Facility Type: Other - RESIDENTIAL TRTMT, EATING

Certificate Type: Waiver

NPI Number: 1669444329

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D2254106
LAB Type	Other - RESIDENTIAL TRTMT, EATING
Facility Name	EMILY PROGRAM COLUMBUS OUTPATIENT
Street	8001 RAVINES EDGE CT #301
City	COLUMBUS
State	OH
ZIP	43235
Phone	888 364-5977
CertificateType	4
CertificateEffectiveDate	2/29/2024
CertificateExpirationDate	2/27/2026
FacilityType	Waiver

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