38D0973548 CLIA NUMBER - IDANHA-DETROIT RFPD

Laboratory Demographics

CLIA Number: 38D0973548

Facility Name: IDANHA-DETROIT RFPD

Facility Address:
160 DETROIT AVE N
DETROIT, OR
ZIP 97342
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Facility Phone Number: 503 854-3494

Facility Type: Ambulance

Certificate Type: Waiver

NPI Number: 1912911868

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	38D0973548
LAB Type	Ambulance
Facility Name	IDANHA-DETROIT RFPD
Street	160 DETROIT AVE N
City	DETROIT
State	OR
ZIP	97342
Phone	503 854-3494
CertificateType	4
CertificateEffectiveDate	5/9/2022
CertificateExpirationDate	5/8/2024
FacilityType	Waiver

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