39D0969203 CLIA NUMBER - BLACKLICK VALLEY FOUND & AMBULANCE

Laboratory Demographics

  • CLIA Code: 39D0969203
  • Facility Name: BLACKLICK VALLEY FOUND & AMBULANCE
  • Facility Address: 1077 FIRST STREET
    NANTY GLO, PA
    ZIP 15943
  • Facility Phone: 814 749-7332
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: BEVERLY SHERWOOD-BURNS
  • NPI Number: 1750495354
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 39D0969203
LAB Type Rural Health Clinic
Facility Name BLACKLICK VALLEY FOUND & AMBULANCE
Street 1077 FIRST STREET
City NANTY GLO
State PA
ZIP 15943
Phone 814 749-7332
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/6/2024
Certificate Expiration Date 1/5/2026
Facility Type Rural Health Clinic
Lab Director BEVERLY SHERWOOD-BURNS

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