37D2199052 CLIA NUMBER - VAO SERVICE PROVIDER, LLC

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Laboratory Demographics

CLIA Number: 37D2199052

Facility Name: VAO SERVICE PROVIDER, LLC

Facility Address:
817 S W 59TH STREET
OKLAHOMA CITY, OK
ZIP 73109
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Facility Phone Number: 405 605-6353

Facility Type: Assisted Living Facility

Certificate Type: Waiver

NPI Number: 1316253008

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	37D2199052
LAB Type	Assisted Living Facility
Facility Name	VAO SERVICE PROVIDER, LLC
Street	817 S W 59TH STREET
City	OKLAHOMA CITY
State	OK
ZIP	73109
Phone	405 605-6353
CertificateType	4
CertificateEffectiveDate	11/5/2022
CertificateExpirationDate	11/4/2024
FacilityType	Waiver

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