38D2090627 CLIA NUMBER - MOSAIC-BEND HIGH SCHOOL-BASED HEALTH CENTER

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Laboratory Demographics

CLIA Number: 38D2090627

Facility Name: MOSAIC-BEND HIGH SCHOOL-BASED HEALTH CENTER

Facility Address:
230 NE 6TH ST
BEND, OR
ZIP 97701
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Facility Phone Number: 541 383-3005

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1316285760

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D2090627
LAB Type	Federally Qualified Health Center
Facility Name	MOSAIC-BEND HIGH SCHOOL-BASED HEALTH CENTER
Street	230 NE 6TH ST
City	BEND
State	OR
ZIP	97701
Phone	541 383-3005
CertificateType	4
CertificateEffectiveDate	4/1/2023
CertificateExpirationDate	3/31/2025
FacilityType	Waiver

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