38D1043839 CLIA NUMBER - ALBERTINA KERR YOUTH AND FAMILY

Laboratory Demographics

CLIA Code: 38D1043839
Facility Name: ALBERTINA KERR YOUTH AND FAMILY
Facility Address: 832 NE 162ND AVE
PORTLAND, OR
ZIP 97230
Facility Phone: 503 802-5258
Facility Type: Other - PED MENTAL HEALTH
Facility Type: Waiver
Lab Director: WALTER MALANOWSKI
NPI Number: 1003030305
Taxonomy: 320800000X - Community Based Residential Treatment Facility, Mental Illness

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CLIA Record

Field Name	Field Value
CLIA Number	38D1043839
LAB Type	Other - PED MENTAL HEALTH
Facility Name	ALBERTINA KERR YOUTH AND FAMILY
Street	832 NE 162ND AVE
City	PORTLAND
State	OR
ZIP	97230
Phone	503 802-5258
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	12/11/2024
Certificate Expiration Date	12/10/2026
Facility Type	Other - PED MENTAL HEALTH
Lab Director	WALTER MALANOWSKI

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