37D0993978 CLIA NUMBER - PROVIDENCE HOME CARE LLC

Laboratory Demographics

  • CLIA Code: 37D0993978
  • Facility Name: PROVIDENCE HOME CARE LLC
  • Facility Address: 2831 NW 59TH ST
    OKLAHOMA CITY, OK
    ZIP 73112
  • Facility Phone: 405 602-3295
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: BRIAN BANKS
  • NPI Number: 1093826695
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 37D0993978
LAB Type Home Health Agency
Facility Name PROVIDENCE HOME CARE LLC
Street 2831 NW 59TH ST
City OKLAHOMA CITY
State OK
ZIP 73112
Phone 405 602-3295
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/30/2023
Certificate Expiration Date 11/29/2025
Facility Type Home Health Agency
Lab Director BRIAN BANKS

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