38D2198719 CLIA NUMBER - COFFEE CREEK CORRECTIONAL FACILITY

Laboratory Demographics

  • CLIA Code: 38D2198719
  • Facility Name: COFFEE CREEK CORRECTIONAL FACILITY
  • Facility Address: 24499 SW GRAHAMS FERRY ROAD
    WILSONVILLE, OR
    ZIP 97070
  • Facility Phone: 503 378-5538
  • Facility Type: Prison
  • Facility Type: Waiver
  • Lab Director: DR. WARREN ROBERTS
  • NPI Number: 1992844195
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 38D2198719
LAB Type Prison
Facility Name COFFEE CREEK CORRECTIONAL FACILITY
Street 24499 SW GRAHAMS FERRY ROAD
City WILSONVILLE
State OR
ZIP 97070
Phone 503 378-5538
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/3/2024
Certificate Expiration Date 11/2/2026
Facility Type Prison
Lab Director DR. WARREN ROBERTS

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