37D0999333 CLIA NUMBER - PROVIDENCE HOUSE

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Field Name	Field Value
CLIA Number	37D0999333
LAB Type	Intermediate Care Facility for Mentally Retarded
Facility Name	PROVIDENCE HOUSE
Street	405 N 20TH ST
City	GUTHRIE
State	OK
ZIP	73044
Phone	405 282-1517
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	5/9/2024
Certificate Expiration Date	5/8/2026
Facility Type	Intermediate Care Facility for Mentally Retarded
Lab Director	CLARA DUEHNING

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